Key result
Baseline resting ECG abnormalities are linked to ~25% higher CVD risk in intermediate-to-high risk adults.
Why the study?
It was unclear whether resting ECG provides additional value beyond traditional risk factors for CVD risk prediction across different cardiovascular risk subgroups.
Does the presence of resting ECG abnormalities improve cardiovascular disease risk prediction beyond traditional risk factors in asymptomatic adults?
Cohort (n=7,872)
No
Does the presence of resting ECG abnormalities improve cardiovascular disease risk prediction beyond traditional risk factors in asymptomatic adults?
Hazard Ratio: 1.25 (95% CI 1.03–1.51)
Absolute Event Rate: 17.1% vs 10.9%
Resting ECG abnormalities marginally improve cardiovascular risk prediction in asymptomatic adults with a 10-year ASCVD risk ≥10%, but provide no significant benefit in low-risk individuals, supporting guidelines against routine screening in the latter group.
ECG abnormalities should not yet alter ASCVD-based risk stratification; leaves open targeted use in adults with ≥10% risk pending prospective validation.
Aims: To examine whether electrocardiography (ECG) could provide additional values to the traditional risk factors for cardiovascular disease (CVD) risk prediction among different cardiovascular risk subgroups. Methods: A total of 7,872 community residents aged ≥40 years were followed up for a median of 4.5 years. A 12-lead resting ECG was examined for participants at baseline. CVD events including myocardial infarction, stroke and cardiovascular mortality were collected. Cox proportional hazards models were used and models of traditional risk factors with and without ECG were compared. Results: At baseline, 2,470 participants (31.3%) had ECG abnormalities. During follow-up, 464 participants developed CVD events. ECG abnormalities were associated with an increased risk of CVD after adjustment for the traditional risk factors in participants with a 10-year atherosclerotic CVD (ASCVD) risk ≥10% (hazard ratio, HR: 1.45; 95% confidence interval, CI: 1.11, 1.91). Adding ECG abnormalities to the traditional CVD risk factors improved reclassification for those who did not experience events [net reclassification index: 8.0% (95% CI: 2%, 19.5%)], discrimination (integrated discrimination improvement: 0.7% (95% CI: 0.1%, 1.9%), and calibration (goodness of fit P value from 0.600 to 0.873) in participants with a 10-year ASCVD risk ≥10%. However, no significant association and improvement were found in participants with a 10-year ASCVD risk <10%. Conclusions: ECG screening might provide a marginal improvement in CVD risk prediction in adults at high risk. However, ECG should not be recommended in adults at low risk.
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Niu et al. (2020) conducted a cohort in Cardiovascular disease (n=7,872). ECG abnormalities vs. No ECG abnormalities was evaluated on Composite of CVD events (nonfatal MI, fatal and nonfatal stroke, and coronary heart disease death) (HR 1.25, 95% CI 1.03-1.51). Baseline resting ECG abnormalities were associated with a 25% increased risk of cardiovascular events compared to no abnormalities, and marginally improved risk prediction in adults with a 10-year ASCVD risk ≥10%.
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