Key result
Persistent T wave abnormalities between ages 50 and 70 carried a higher risk for future mortality compared with new or reverted abnormalities.
Why the study?
Do persistent ischaemic ECG abnormalities on repeated examinations predict cardiovascular disease and mortality in middle-aged men?
Cohort (n=2,322)
Do persistent ischaemic ECG abnormalities on repeated examinations predict cardiovascular disease and mortality in middle-aged men?
Persistent ischemic ECG abnormalities over a 20-year period independently predict a significantly higher risk of cardiovascular and overall mortality compared to new or reverted abnormalities, supporting the value of serial ECGs for risk assessment.
Answers are grounded in this paper and cite their sources.
Persistent T-wave changes may flag higher mortality risk; leaves open whether serial ECG monitoring improves outcomes.
OBJECTIVE: To determine the effect of new, persistent or reverted ischaemic ECG abnormalities at ages 50 and 70 years on the risk of subsequent cardiovascular disease. DESIGN, SETTING AND PARTICIPANTS: A prospective community-based observational cohort of 50-year-old men in Sweden, followed for 32 years. 2322 men of age 50 years participated in 1970-3, and 1221 subjects were re-examined at the age of 70 years. MAIN OUTCOME MEASURES: Myocardial infarction (MI), cardiovascular mortality and overall mortality. RESULTS: At 50 years of age, after adjusting for established conventional risk factors, T wave abnormalities, ST segment depression, major Q/QS pattern and ECG-left ventricular hypertrophy were all found to be independent risk factors for the main outcome measures during the 32 years of follow-up. When ECG variables were re-measured at 70 years of age, they were still found to be independent risk factors for the mortality outcomes, but lost in significance for prediction of MI. Regarding mortality, it was twice as dangerous to have persistent T wave abnormalities (HR 4.63; 95% CI 2.18 to 9.83) or ST segment depression (HR 5.66; 95% CI 1.77 to 18.1), as with new T wave abnormalities (HR 2.20; 95% CI 1.48 to 3.29) or ST segment depression (HR 2.55; 95% CI 1.74 to 3.75), developing between ages 50 and 70 years. The addition of "ECG indicating ischaemia" significantly increased the predictive power of the Framingham score (p<0.001). CONCLUSIONS: It is worthwhile to obtain serial ECGs for proper risk assessment, since persistent ST-T abnormalities carried twice as high a risk for future mortality compared with new or reverted abnormalities.
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Møller et al. (2007) conducted a cohort in Cardiovascular disease (n=2,322). Persistent ischaemic ECG abnormalities (T wave abnormalities or ST segment depression) vs. New or reverted ECG abnormalities was evaluated on Myocardial infarction, cardiovascular mortality, and overall mortality (HR 4.63, 95% CI 2.18 to 9.83). Persistent T wave abnormalities between ages 50 and 70 carried a higher risk for future mortality compared with new or reverted abnormalities.
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