Key result
Precordial ST-depression linked to ~4-fold higher cardiovascular mortality in older men.
Why the study?
Do electrocardiographic precordial ST-segment deviations predict cardiovascular death in a primary care population without overt ischemic heart disease?
Cohort (n=285,194)
No
Do electrocardiographic precordial ST-segment deviations predict cardiovascular death in a primary care population without overt ischemic heart disease?
Precordial ST-segment deviations on routine ECG have distinct, lead-specific, and demographic-specific prognostic implications for cardiovascular death in primary care patients.
Answers are grounded in this paper and cite their sources.
ST deviations may refine CV death risk assessment in primary care without overt IHD; leaves open whether findings are causal or should alter practice.
BACKGROUND: We sought to perform a study assessing the association between electrocardiographic ST-segment deviations and cardiovascular death (CVD), in relation to sex and age (≥ and <65 years), in a large primary care population without overt ischemic heart disease. METHODS AND RESULTS: Using computerized analysis of ECGs from 285 194 persons, we evaluated the association between precordial ST-segment deviations and the risk of CVD. All data on medication, comorbidity, and outcomes were retrieved from Danish registries. After a median follow-up period of 5.8 years, there were 6679 cardiovascular deaths. Increasing ST-depression was associated with an increased risk of CVD in almost all of the precordial leads, with the most robust association seen in lead V5 to V6. ST-elevations in lead V2 to V6 were associated with increased risk of CVD in young women, but not in men. However, ST-elevations in V1 increased the risk for both genders and age groups, exemplified by a HR of 1.80 (95% CI [1.19 to 2.74], P=0.005) for men <65 years with ST-elevations ≥ 150 μV versus a nondeviating ST-segment (-50 μV to +50 μV). In contrast, for men <65 years, ST-elevations in lead V2 to V3 conferred a decreased risk of CVD with a HR of 0.77 (95% CI [0.62 to 0.96], P<0.001) for ST-elevations ≥ 150 μV in V2. CONCLUSION: We found that ST-depressions were associated with a dose-responsive increased risk of CVD in nearly all the precordial leads. ST-elevations conferred an increased risk of CVD in women and with regard to lead V1 also in men. However, ST-elevations in V2 to V3 were associated with a decreased risk of CVD in young men.
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Rasmussen et al. (2014) conducted a cohort in Electrocardiographic precordial ST-segment deviations in primary care patients without overt ischemic heart disease (n=285,194). Precordial ST-segment deviations (e.g., ST-depression ≥150 μV in lead V5 in men ≥65 years) vs. Nondeviating ST-segment (-50 μV to +50 μV) was evaluated on Cardiovascular death (ICD-10: I00-I99) (HR 3.99, 95% CI 2.69-5.92, p=<0.0001). Precordial ST-depressions dose-dependently increased cardiovascular death risk (HR 3.99 in older men for V5 ≥150 μV), while V2-V3 ST-elevations reduced risk in young men (HR 0.77 for V2 ≥150 μV).
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