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(Circulation. 2008;118:2790-2796.)
© 2008 American Heart Association, Inc.

Epidemiology

Prevalence, Prognosis, and Implications of Isolated Minor Nonspecific ST-Segment and T-Wave Abnormalities in Older Adults

Cardiovascular Health Study

Anita Kumar, MD; Ronald J. Prineas, MD, PhD; Alice M. Arnold, PhD; Bruce M. Psaty, MD, PhD; Curt D. Furberg, MD, PhD; John Robbins, MD; Donald M. Lloyd-Jones, MD, ScM

From the Department of Preventive Medicine and Bluhm Cardiovascular Institute, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.K., D.M.L.-J.); Department of Epidemiology, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (R.J.P., C.D.F.); Department of Biostatistics (A.M.A.) and Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services (B.M.P.), University of Washington, Seattle; Center for Health Studies, Group Health, Seattle, Wash (B.M.P.); and Department of Internal Medicine, University of California Davis, Sacramento (J.R.).

Correspondence to Donald M. Lloyd-Jones, MD, ScM, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lake Shore Dr, Suite 1102, Chicago, IL 60611. E-mail dlj{at}northwestern.edu

Received February 11, 2008; accepted October 10, 2008.

Background— The prevalence and prognostic significance of isolated minor nonspecific ST-segment and T-wave abnormalities (NSSTTAs) in older adults are poorly understood.

Methods and Results— Cardiovascular Health Study participants free of both clinical cardiovascular disease and major ECG abnormalities were included. We examined the prospective association of isolated minor NSSTTAs (defined by Minnesota Codes 4–3, 4–4, 5–3, and 5–4) with total, cardiovascular, and coronary mortality and incident nonfatal myocardial infarction. Among 3224 participants (61.9% women; mean age, 72 years), 233 (7.2%) had isolated NSSTTAs at baseline. Covariates associated with isolated NSSTTAs included older age, nonwhite race (20.5% of blacks versus 4.8% of whites; P<0.001), diabetes, and higher blood pressure and body mass index but not the presence of subclinical cardiovascular disease. After 39 518 person-years of follow-up, the presence of isolated NSSTTAs was associated with significantly increased risk for coronary heart disease mortality (multivariable-adjusted hazards ratio, 1.76; 95% CI, 1.18 to 2.61) but not with incident nonfatal myocardial infarction (multivariable-adjusted hazards ratio, 0.71; 95% CI, 0.43 to 1.17). The association of isolated NSSTTAs with coronary death was independent of subclinical atherosclerosis and left ventricular mass measures. In secondary analyses, among those with cardiac death, there was a significantly higher rate of primary arrhythmic death (32.3% versus 15.4%; P=0.02) in participants with isolated NSSTTAs versus those without NSSTTAs.

Conclusions— Isolated NSSTTAs are common in older Americans and are associated with significantly increased risk for coronary death. However, isolated NSSTTAs are not associated with incident nonfatal myocardial infarction, suggesting that they are associated particularly with increased risk for primary arrhythmic death.

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CLINICAL PERSPECTIVE

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Clinical Summaries
Circulation 2008 118: 2667-2668. [Extract] [Full Text]