Association of Major and Minor ECG Abnormalities With Coronary Heart Disease Events

Abstract

ContextIn populations of older adults, prediction of coronary heart disease (CHD) events through traditional risk factors is less accurate than in middle-aged adults. Electrocardiographic (ECG) abnormalities are common in older adults and might be of value for CHD prediction.Objective To determine whether baseline ECG abnormalities or development of new and persistent ECG abnormalities are associated with increased CHD events. Design, Setting, and ParticipantsA population-based study of 2192 white and black older adults aged 70 to 79 years from the Health, Aging, and Body Composition Study (Health ABC Study) without known cardiovascular disease. Adjudicated CHD events were collected over 8 years between 1997-1998 and 2006-2007. Baseline and 4-year ECG abnormalities were classified according to the Minnesota Code as major and minor. Using Cox proportional hazards regression models, the addition of ECG abnormalities to traditional risk factors were examined to predict CHD events.Main Outcome Measure Adjudicated CHD events (acute myocardial infarction [MI], CHD death, and hospitalization for angina or coronary revascularization).Results At baseline, 276 participants (13%) had minor and 506 (23%) had major ECG abnormalities. During follow-up, 351 participants had CHD events (96 CHD deaths, 101 acute MIs, and 154 hospitalizations for angina or coronary revascularizations). Both baseline minor and major ECG abnormalities were associated with an increased risk of CHD after adjustment for traditional risk factors (17.2 per 1000 person-years among those with no abnormalities; 29.3 per 1000 person-years; hazard ratio [HR], 1.35; 95% CI, 1.02-1.81; for minor abnormalities; and 31.6 per 1000 person-years; HR, 1.51; 95% CI, 1.20-1.90; for major abnormalities). When ECG abnormalities were added to a model containing traditional risk factors alone, 13.6% of intermediate-risk participants with both major and minor ECG abnormalities were correctly reclassified (overall net reclassification improvement [NRI], 7.4%; 95% CI, 3.1%-19.0%; integrated discrimination improvement, 0.99%; 95% CI, 0.32%-2.15%). After 4 years, 208 participants had new and 416 had persistent abnormalities. Both new and persistent ECG abnormalities were associated with an increased risk of subsequent CHD events (HR, 2.01; 95% CI, 1.33-3.02; and HR, 1.66; 95% CI, 1.18-2.34; respectively). When added to the Framingham Risk Score, the NRI was not significant (5.7%; 95% CI, −0.4% to 11.8%). ConclusionsMajor and minor ECG abnormalities among older adults were associated with an increased risk of CHD events. Depending on the model, adding ECG abnormalities was associated with improved risk prediction beyond traditional risk factors.

Soluble Urokinase Plasminogen Activator Receptor for Risk Prediction in Patients Admitted with Acute Chest Pain

“…Iversen), who was blinded to follow-up data, and were divided into normal ECGs and abnormal ECGs (signs of acute or previous ischemic heart disease, i.e., Q-waves, ST-depression, T-wave inversion, or bundle-branch block). A recent study has suggested the validity of this distinction of ECG changes for prediction of adverse coronary events (12 ).…”

Electrocardiographic Abnormalities in the Elderly: A Study in a Large Database of Primary Care Patients

“…The common ECG abnormalities in ChD are right bundle-branch block (RBBB), often associated with left anterior hemiblock (LAH), and abnormalities of the conduction system, such as bradyarrhythmias and tachyarrhythmias [14]. In a previous analysis of the same database, Chagas disease was strongly associated with pacemaker rhythm (odds ratio Minor and major ECGs abnormalities are significantly associated with an increased risk of coronary heart disease, and they have been associated with improved risk prediction beyond traditional risk factors [18]. For example, LVH detected with standard ECG is a strong independent predictor of myocardial infarction, stroke, congestive heart failure and sudden cardiac death [19,20], and is associated with a poor prognosis in very old men and women [21].…”

Major Electrocardiographic Abnormalities and 25‐Hydroxy Vitamin D Deficiency: Insights from National Health and Nutrition Examination Survey‐III

“…13 Major and minor electrocardiogram (ECG) abnormalities have been demonstrated to be strong independent predictors of cardiovascular events and mortality. 14,15 overall clinical net reclassification of 3.6% in the National Health and Nutrition Examination Survey-III (NHANES-III) cohort 16 and 7.4% in an elderly cohort. 14 Studies exploring the association of vitamin D with various ECG abnormalities are scarce.…”

“…14,15 overall clinical net reclassification of 3.6% in the National Health and Nutrition Examination Survey-III (NHANES-III) cohort 16 and 7.4% in an elderly cohort. 14 Studies exploring the association of vitamin D with various ECG abnormalities are scarce. 10,17 To the best of our knowledge, the association between vitamin D levels and major ECG abnormalities has not been studied.…”