Antiochos P, Ge Y, Steel K, et al. - This study was intended to assess the incremental prognostic value of unrecognized myocardial infarction (UMI), detected during the assessment of coronary artery disease (CAD) by stress cardiac magnetic resonance (CMR), beyond cardiac function, and ischemia. The multicenter SPINS (Stress CMR Perfusion Imaging in the United States) study was conducted to analyze 2,349 consecutive patients (63 ± 11 years of age, 53% were male) with suspected CAD by stress CMR and followed over a median of 5.4 years. Researchers characterized UMI as the presence of late gadolinium enhancement consistent with MI in the absence of a medical history of MI. This research evaluated the correlation of UMI with all-cause mortality and nonfatal MI (death and/or MI), and major adverse cardiac events. They diagnosed UMI in 347 patients (14.8%) and clinically recognized myocardial infarction (RMI) in 358 patients (15.2%). The presence of UMI or RMI portended an equally significant risk for death and/or MI, independently of the presence of ischemia in a multicenter cohort of patients with suspected CAD. Those with UMI were less likely to receive guideline-directed medical therapies compared with RMI patients, and presented an elevated risk for heart failure hospitalization that needs further study.