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ECG abnormalities in postmenopausal women signal increased risk ▸

Little data exist on the prevalence, incidence and prognostic value of ECG abnormalities in asymptomatic postmenopausal women. Denes et al looked at the ECGs of 14 749 women enrolled in the Women’s Health Initiative Study, all of whom were healthy postmenopausal women randomised to receive oestrogen and progestin or placebo. The Novacode criteria were used to stratify ECG abnormalities. End points included coronary heart disease (CHD) and cardiovascular disease (CVD) events.

Overall, there were 118 incident events among 9744 women with normal ECGs, 91 among those with minor abnormalities and 37 among those with major abnormalities. The incident annual CHD event rates per 10 000 women with absent, minor or major ECG abnormalities were 21 (95% CI 18 to 26), 40 (95% CI 32 to 49) and 75 (95% CI 54 to 104), respectively. The adjusted hazard ratios for CHD events were 1.55 for minor and 3.01 for major baseline abnormalities. After 3 years of follow-up, 5% of women who had a normal ECG at baseline developed new ECG abnormalities, with an annual CHD event rate of 85 per 10 000 women. There were no significant interactions between assignment for hormone treatment and ECG abnormalities for prediction of risk of cardiovascular end points. For prediction of CHD events, the addition of ECG findings to the Framingham risk score increased the area under the receiver operating characteristic curve from 0.69 to 0.74.

Therefore, in this study, all ECG abnormalities were independently associated with an increased risk of cardiovascular events and mortality, and this information was incremental to the established methods of risk stratification.

Patients with myocardial infarction admitted over the weekend have higher mortality rates ▸

Are patients admitted with myocardial infarction over the weekend at higher risk than those admitted during the week?

Using the Myocardial Infarction Data Acquisition System (MIDAS), Kostis and colleagues retrospectively examined all admissions for myocardial infarction in the …

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