I t has been 30 years since the first report from the Framingham study demonstrated that silent or unrecognized myocardial infarction (MI), defined as evidence of MI on electrocardiography (ECG) in the absence of a history of MI, is associated with a greater risk of all-cause death, heart failure, and fatal MI (1). Despite this finding, silent MIs are rarely included as a component of clinical endpoints in randomized controlled trials. Clinical endpoints should be clinically meaningful (2). MI presents in a wide variety of ways across a broad spectrum of clinical settings. The severity of MI can range from silent to life threatening, and can occur in a wide variety of clinical settings such as stent thrombosis–related or procedural-related MI (3). As a result, there are different classification schemes, and thresholds to define MI (3). Silent MI is no exception to the rule. The definition depends on the methods used to identify the MI: ECG characteristics based on the Minnesota Classification (appearance of a Q-wave, abnormalities of the ST-segment or T-wave), stress echocardiography, dipyridamole scintigraphy, or cardiac magnetic resonance (4). Silent MI has variably been included as a component of composite endpoints in clinical trials to this point. (5).

中文翻译：

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无症状心肌梗塞

自从 Framingham 研究的第一份报告表明无症状或未被识别的心肌梗塞 (MI) 被定义为在没有 MI 病史的情况下心电图 (ECG) 上的 MI 证据以来，已经过去了 30 年全因死亡、心力衰竭和致命性 MI (1)。尽管有这一发现，但在随机对照试验中，很少将无症状 MI 作为临床终点的一个组成部分。临床终点应具有临床意义 (2​​)。MI 在广泛的临床环境中以多种方式呈现。MI 的严重程度可以从无症状到危及生命，并且可以发生在多种临床环境中，例如支架血栓相关或手术相关的 MI (3)。因此，存在不同的分类方案和定义 MI (3) 的阈值。无声 MI 也不例外。该定义取决于用于识别 MI 的方法：基于明尼苏达分类的 ECG 特征（Q 波的出现、ST 段或 T 波的异常）、负荷超声心动图、双嘧达莫闪烁显像或心脏磁共振（ 4）。到目前为止，在临床试验中，无声 MI 一直被作为复合终点的一个组成部分。(5).