Abstract 3618: Prevalence, Prognosis and Implications of Isolated Non-Specific ST-Segment and T-Wave Abnormalities in Older Adults: Cardiovascular Health Study
Background: The prevalence and prognostic significance of isolated non-specific ST-segment and T-wave abnormalities (NSSTTA) in older adults are poorly understood.
Methods: Cardiovascular Health Study participants free of clinical cardiovascular disease (CVD) and major electrocardiographic abnormalities were included. We examined the prospective association of isolated NSSTTA (defined by Minnesota codes 4 –3, 4 – 4, 5–3 and 5– 4) with incident CVD and coronary (CHD) death and non-fatal events.
Results: Among 3224 participants (61.9% women, mean age 72 years), 233 (7.2%) had isolated NSSTTA at baseline. Covariates associated with isolated NSSTTA included older age, non-white race (20.5% of blacks vs. 4.8% of whites; P<0.001), diabetes, higher blood pressure and higher body mass index, but not presence of subclinical CVD. After 33,965 person-years of follow-up, presence of isolated NSSTTA was associated with increased risk for all-cause mortality, and particularly CHD death, but not incident MI (See Table⇓). The association of isolated NSSTTA with CHD death was independent of subclinical atherosclerosis, left ventricular (LV) systolic dysfunction and LV mass measures. Secondary analyses of the mechanism leading to a CHD death demonstrated a substantially higher rate of adjudicated primary arrhythmic death in participants with isolated NSSTTA versus those without NSSTTA. Isolated NSSTTA were associated with similar increases in risk for death in men and women, in whites and blacks, and in those with and without subclinical CVD (all P for interaction ≥0.1).
Conclusions: Isolated NSSTTA are common in older Americans, and they are associated with substantially increased risk for CHD death. However, isolated NSSTTA are not associated with incident MI, suggesting the hypothesis that they increase risk for arrhythmic, not ischemic, causes of death.