Predictive Value of ECG Ischemic Pattern Changes for the 10‐Year Occurrence of Ischemic Heart Disease

Background The long‐term prognostic value of resting electrocardiogram (ECG) in the prediction of ischemic heart disease (IHD) incidence and mortality in the asymptomatic middle‐aged population is not well characterized. This study was designed to assess the prognostic value of major and minor ischemic changes in ECG as a potential screening tool in healthy adults. Methods A total of 9035 middle‐aged subjects with available ECGs were recruited. ECG ischemia was classified using the Minnesota Coding system. All the participants were followed up regarding the occurrence of IHD over 10 years. A cardiologist confirmed IHD, and additional tests were performed if indicated. Multiple logistic regression was applied to estimate the odds of ischemic changes in ECG to predict the occurrence of IHD. A p ‐value less than 0.05 was considered significant. Results Among 9035 participants, 1225 (13.6%) had major ischemic changes and 1088 (12.0%) had minor ischemic changes. After a 10‐year follow‐up, 747 (8.3%) were confirmed with IHD (124 had died and 623 survived). IHD was more prevalent among men, older people, smokers, and retired subjects ( p < 0.001). Both major and minor ischemic changes were significantly higher in participants with IHD ( p = 0.001), while only major ischemic changes were associated with IHD‐cause mortality ( p = 0.004). These relationships remained significant after adjustment for confounding factors. Conclusion Both minor and major isolated abnormalities in ECG are associated with an increased risk of long‐term IHD incidence in the middle‐aged population, while only combined major ischemia increases the odds of death caused by IHD.