Major resting ECG abnormality was associated with a significantly increased likelihood of myocardial ischemia (OR 2.51) and future major adverse cardiac events in patients with known or suspected chronic coronary artery disease.
Cohort (n=495)
No
Does resting ECG abnormality predict myocardial ischemia and major adverse cardiac events in patients with known or suspected chronic CAD?
Resting ECG abnormalities provide significant incremental diagnostic and prognostic value for predicting myocardial ischemia and major adverse cardiac events in patients with chronic CAD.
Effect estimate: OR 2.51 (95% CI 1.44-4.36)
Absolute Event Rate: 36.8% vs 17.2%
p-value: p=0.001
BACKGROUND: Electrocardiography (ECG) is an essential investigation in patients with chronic coronary artery disease (CAD). However, evidence regarding the diagnostic and prognostic value of ECG in this population is limited. Therefore, we sought to determine whether baseline ECG abnormalities were associated with myocardial ischemia and cardiac events in patients with known or suspected chronic CAD. METHODS: Consecutive patients with known (n = 146) or suspected chronic CAD (n = 349) referred for adenosine stress cardiac magnetic resonance (CMR) between 2011 and 2014 were enrolled. Resting ECGs were classified as major, minor, and no abnormalities. Predictors of myocardial ischemia on CMR and major adverse cardiac events (MACE) including cardiac death, nonfatal myocardial infarction, hospitalization for heart failure and late revascularization (> 180 days after CMR) were evaluated. RESULTS: Average age was 69 ± 11 years (51% men). One hundred and eighty-five patients (37.4%) had major and 154 (31.1%) had minor ECG abnormalities. In patients with suspected CAD, myocardial ischemia was presented in 83 patients (23.8%). Multivariable analysis demonstrated major ECG abnormality as the strongest predictor of myocardial ischemia (HR 2.51; 95% CI 1.44-4.36; p = 0.001). Adding ECG to clinical pretest probability models improved the prediction of myocardial ischemia in ROC analyses (p = 0.04). In the whole cohort (n = 495), 91 MACE occurred during the median follow-up period of 4.8 years. Multivariable analysis showed that diabetes mellites, history of heart failure, prior revascularization, left ventricular ejection fraction, ischemia, and major ECG abnormality were independent predictors of MACE. CONCLUSION: Abnormal resting ECG is common in patients with known or suspected chronic CAD. ECG had important diagnostic and prognostic values in this population.
Kaolawanich et al. (Wed,) conducted a cohort in Known or suspected chronic coronary artery disease (n=495). Major resting ECG abnormality vs. No ECG abnormality was evaluated on Myocardial ischemia on CMR (OR 2.51, 95% CI 1.44-4.36, p=0.001). Major resting ECG abnormality was associated with a significantly increased likelihood of myocardial ischemia (OR 2.51) and future major adverse cardiac events in patients with known or suspected chronic coronary artery disease.