Objective Cardiovascular diseases (CVDs) are highly preventable non-communicable diseases. ECG is a potential tool for risk stratification with respect to CVD. Our aim was to evaluate ECG’s role in all-cause and cardiovascular mortality prediction.
Methods Participants from the Brazilian Longitudinal Study of Adult Health, free of known CVD at baseline were included. A 12-lead ECG was obtained at baseline (2008–2010). Participants were followed up to 2018 by annual interviews. Deaths were independently reviewed. Cox as well as Fine and Grey multivariable regression models were applied to evaluate if the presence of any major electrocardiographic abnormality (MEA), defined according to the Minnesota Code system, would predict total and cardiovascular deaths. We also evaluated the Net Reclassification Index of adding MEA to the Systematic Coronary Risk Evaluation (SCORE).
Results The 13 428 participants (median age 51 years, 45% men) were followed up for 8±1 years. All-cause and cardiovascular mortality occurred in 2.8% and 1.2% of the population, respectively. Prevalent MEA was an independent predictor of overall (HR=2.3, 95% CI 1.7 to 2.9) and cardiovascular mortality (HR=4.6, 95% CI 3.0 to 7.0) after adjustments for age, race, education and traditional cardiovascular risk factors. Adding MEA to the SCORE resulted in 9% mis-reclassification in the non-event subgroup and 33% correct reclassification in those with a fatal cardiovascular event.
Conclusion Presence of MEA was an independent predictor of overall and cardiovascular mortality. ECG may have a role in risk prediction of cardiovascular mortality in primary care.
- cardiac risk factors and prevention
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Contributors MMP-F, LCB and ALPR contributed to the conception or design of the work. SMB, LG, BBD, PAL, MdJMdF, MdCCdA and JGM contributed to the acquisition of dat. MMP-F, LCB, RPdR and ALPR to the analysis or interpretation of data for the work. MMP-F, LCB, SMB and ALPR drafted the manuscript and all critically revised the manuscript. All gave the final approval and agreed to be accountable for all aspects of the work ensuring integrity and accuracy.
Funding The ELSA‐Brasil baseline study was supported by the Brazilian Ministries of Health and of Science and Technology (grants 01060010.00RS, 01060212.00BA, 01060300.00ES, 01060278.00MG MG, 01060115.00SP and 01060071.00RJ). PAL, SMB, LG and ALPR are supported by a research grant from CNPq. ALPR is also supported by a research grant (Pesquisador Mineiro) from FAPEMIG, the research agency of the State of Minas Gerais, Brazil.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The study was approved by local ethics committees of the six participating institutions and complies with the Declaration of Helsinki (Comitê de Ética em Pesquisa da UFMG Approval ETIC 186/6).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All relevant data were included. All data are available.
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