Subclinical Myocardial Injury Identified by Cardiac Infarction/Injury Score and the Risk of Mortality in Men and Women Free of Cardiovascular Disease

Abstract

Previous studies have explored the ability of the Cardiac Infarction/Injury Score (CIIS) to identify individuals who are high-risk for cardiovascular disease (CVD) mortality. However, its prognostic significance among those without CVD in the United States general population has not been established. This analysis included 6,298 participants (mean age: 59 ± 13 years; 53% female; 51% non-whites) from the Third National Health and Nutrition Examination Survey (NHANES III), excluding participants with a history of CVD or electrocardiographic evidence of old myocardial infarction or ischemic ST depression at baseline. Subclinical myocardial injury was defined as CIIS ≥10. Mortality data were ascertained using the National Death Index. Cox proportional-hazards regression was used to compute hazard ratios (HR) and 95% confidence intervals (CI) for association between subclinical myocardial injury with CVD and all-cause mortalities. Subclinical myocardial injury was detected in 1,376 (22%) participants. A total of 1,928 deaths occurred during a median of 14 years follow-up, of which 765 (40%) were due to CVD. In a multivariable model adjusted for demographics, traditional CVD risk factors, and other medical comorbidities, subclinical myocardial injury was associated with an increased risk of CVD (HR=1.26, 95%CI=1.02, 1.56) and all-cause (HR=1.42, 95%CI=1.23, 1.63) mortalities. In conclusion, subclinical myocardial injury in persons without manifestations of CVD is associated with an increased risk of CVD and all-cause mortalities. These findings highlight the important role of CIIS to identify subclinical myocardial injury and its association with mortality among men and women in the United States.

Vitamin D deficiency and electrocardiographic subclinical myocardial injury: Results from National Health and Nutrition Examination Survey‐III

“…The application of CIIS in this study was to find individuals without clinical CVD but who were at an increased risk of CVD and all‐cause mortalities. CIIS has been shown to predict CVD and all‐cause mortalities among those without apparent CVD . Other electrocardiographic markers which are also associated with increased mortality include QRS duration and minor Q waves, but they only rely on 1 or 2 data points .…”

“…Subclinical myocardial injury (SC-MI) as defined by CIIS ≥ 10, in those without manifestations of CVD has been associated with an increased risk of CVD and all-cause mortalities. 11 These findings highlight the important role of CIIS to identify SC-MI.…”

“…This score uses electrocardiographic features that often are missed with conventional criteria for the diagnosis of myocardial infarction or injury, such as abnormal T‐wave amplitude and direction. Subclinical myocardial injury (SC‐MI) as defined by CIIS ≥ 10, in those without manifestations of CVD has been associated with an increased risk of CVD and all‐cause mortalities . These findings highlight the important role of CIIS to identify SC‐MI.…”

Association of obesity phenotypes with electrocardiographic subclinical myocardial injury in the general population

“…The score is defined by a combination of 11 discrete and four continuous features and provides a simple scoring scheme suitable for both visual and computer classification of a standard 12‐lead ECG. SC‐MI was defined as CIIS values ≥10 points …”

“…One such marker is the cardiac infarction/injury score (CIIS), an electrocardiographic‐based scoring system used to define subclinical myocardial injury (SC‐MI) . CIIS has been associated with future adverse events such as coronary heart disease (CHD), cardiovascular and all‐cause mortality . An examination of the association of obesity phenotypes with a marker of SC‐MI using 12‐lead electrocardiogram is a simple and cost‐effective way to stratify the CVD risk associated with these phenotypes.…”