Regular paper
Impact of minor electrocardiographic ST-segment and/or T-wave abnormalities on cardiovascular mortality during long-term follow-up

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Abstract

Minor ST-T abnormalities are common on the resting electrocardiogram of otherwise healthy persons, but the long-term importance of these findings has not been extensively evaluated, especially in women. In a prospective study, 7,985 women and 9,630 men (aged 40 to 64 years at baseline) without other electrocardiographic abnormalities and free of previous coronary heart disease (CHD) were studied using Cox regression for 22-years of follow-up. Primary outcomes were death from CHD and total cardiovascular disease (CVD); total mortality was a secondary outcome. Minnesota Code was employed to assess the presence or absence of electrocardiographic abnormalities. Analyses compared persons with minor Minnesota Code ST-segment (codes 4–3 or 4–4) or T-wave findings (codes 5–3 or 5–4) to those with normal electrocardiographic findings. In combined analyses of men and women adjusted for age, isolated minor T-wave abnormality, minor ST-segment depression, or a combination of minor ST-segment and T-wave abnormalities were each associated with increased mortality risks. For CHD mortality, hazard ratios (HRs) ranged from 1.60 to 2.10; for CVD mortality, HRs ranged from 1.50 to 1.95; and for total mortality, HRs ranged from 1.31 to 1.50 (p <0.05 for all HRs). In separate analyses by gender adjusted for age, increased risks were observed for combined ST-T-wave abnormalities in both genders for CHD and CVD mortality (HR 1.72 to 1.75 for men, p <0.05; HR 2.07 to 2.51 for women, p <0.001). These data indicate that nonspecific (minor) ST-segment depression and/or T-wave abnormalities have a long-term prognostic impact for CHD and CVD death in middle-aged women and men and can be considered markers of heightened CHD and CVD risk.

Section snippets

Study population

The Chicago Heart Association Detection Project in Industry is a prospective investigation of 39,573 women and men. The baseline survey was conducted from 1967 to 1973 in 84 cooperating companies and organizations in the Chicago area.16 The current analysis is limited to 18,972 Caucasian and African-American women and men, ages 40 to 64 years at baseline. Younger persons were excluded because of the small number of cardiovascular events in follow-up (especially in women). Older persons were

Baseline risk factor characteristics

Women and men with ST and/or T abnormalities, compared with those free of any ECG abnormality, were generally older and had higher serum cholesterol, blood pressures, 1-hour postload glucose, prevalence of diabetes, and hypertensive medication usage (Table 1).

Prevalence of ST and/or T abnormalities

The age-adjusted prevalence of minor T-wave abnormalities was 1.9% in women and 1.6% in men. For minor ST-segment depression only, the age-adjusted prevalence was 1.5% in women and 1.2% in men. These differences were not statistically

Discussion

This study demonstrated significant increases in age-adjusted risks of CHD, CVD, and total mortality over 22 years in women and men combined in association with isolated minor ST-segment and/or T-wave abnormalities. The combined analysis was justified by the absence of interaction by gender. Age-adjusted HRs—nearly all statistically significant—may be a better reflection of actual risk faced by patients due to possible over-adjustment in multivariate models, most of which showed some degree of

Acknowledgements

A list of colleagues who contributed to earlier aspects of this work has been published (Cardiology 1993;82:191–222).

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    This work was supported by the American Heart Association, Dallas, Texas and by its Chicago and Illinois affiliates; grants HL 15174, HL 21010, and HL 03387 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland; and by the Chicago Health Research Foundation, Chicago, Illinois.

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