Key result
In patients at high cardiovascular risk, the presence of intraventricular conduction delay on baseline ECG independently predicted a 3.7-fold increased risk of major adverse cardiovascular events.
Why the study?
Data are limited regarding the prevalence of ECG abnormalities and their value for predicting major adverse cardiovascular events in patients at high cardiovascular risk.
Do baseline ECG abnormalities predict major adverse cardiovascular events in patients at high cardiovascular risk?
Cohort (n=2,009)
Yes
Do baseline ECG abnormalities predict major adverse cardiovascular events in patients at high cardiovascular risk?
Hazard Ratio: 3.71 (95% CI 2.22–6.23)
p-value: p=<0.001
Adding baseline ECG data to conventional risk factors significantly improves the prediction of major adverse cardiovascular events in patients at high cardiovascular risk.
May aid risk stratification beyond conventional factors; leaves open prospective validation and outcome impact.
BACKGROUND: There are limited data on the prevalence of electrocardiographic (ECG) abnormalities, and their value for predicting a major adverse cardiovascular event (MACE) in patients at high cardiovascular risk. This study aimed to determine the prevalence of ECG abnormalities in patients at high risk for cardiovascular events, and to identify ECG abnormalities that significantly predict MACE. METHODS: Patients aged ≥ 45 years with established atherosclerotic disease (EAD) were consecutively enrolled from the outpatient clinics of the six participating hospitals during April 2011 to March 2014. The following data were collected: demographic data, cardiovascular risk factors, history of cardiovascular event, physical examination, ECG and medications. ECG was analyzed using Minnesota Code criteria. MACE included cardiovascular death, non-fatal myocardial infarction, and hospitalization due to unstable angina or heart failure. RESULTS: A total of 2009 patients were included, 1048 patients (52.2%) had established EAD, and 961 patients (47.8%) had multiple risk factors (MRF). ECG abnormalities included atrial fibrillation (6.7%), premature ventricular contraction (5.4%), pathological Q-wave (Q/QS) (21.3%), T-wave inversion (20.0%), intraventricular ventricular conduction delay (IVCD) (7.3%), left ventricular hypertrophy (LVH) (12.2%), and AV block (12.5%). MACE occurred in 88 patients (4.4%). Independent predictors of MACE were chronic kidney disease, EAD, and the presence of atrial fibrillation, Q/QS, IVCD or LVH by ECG. CONCLUSIONS: A high prevalence of ECG abnormalities was found. The prevalence of ECG abnormalities was high even among those with risk factors without documented cardiovascular disease.
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Krittayaphong et al. (2019) conducted a cohort in High cardiovascular risk (established atherosclerotic disease or multiple risk factors) (n=2,009). Intraventricular conduction delay (IVCD) vs. Absence of IVCD was evaluated on Major adverse cardiovascular event (MACE) (HR 3.71, 95% CI 2.22-6.23, p=<0.001). In patients at high cardiovascular risk, the presence of intraventricular conduction delay on baseline ECG independently predicted a 3.7-fold increased risk of major adverse cardiovascular events.
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