Abstract 14352: Life-Time Risk of Cardiovascular Death in Persons with Electrocardiographic ST-T Changes

Abstract

Objective Electrocardiographic ST-T changes are known predictors of short-term CVD mortality among persons without known CVD. However, there is limited data of life-time risk of CVD mortality in the general population.

Method Electrocardiograms from persons participating in at least one of the first four rounds of the Copenhagen City Heart Study were coded according to the Minnesota Criteria. Persons with known CVD were excluded. Association of CVD mortality to minor, intermediate and major ST-T changes, defined as Minnesota Codes 4-5.3, 4-5.2 and 4-5.1, was examined. Stratified by gender multivariable Cox Models adjusted for conventional risk factors (age, blood pressure, diabetes, smoking and cholesterol) were made using time-dependent covariates of persons participating in more than one round.

Results In all, 18,361 persons without known CVD at time of first inclusion were identified. A total of 41,800 observations were made in round 1-4 of the Copenhagen City Heart Study. During a median of 20.5 and a maximum of 35.3 years of follow-up, 3,839 end-points occurred. Minor ST-T changes were present in 1,319, intermediate in 609 and major in 139 persons at inclusion. During all four rounds 2,215, 1,521 and 384 observations with ST-T changes were recorded. The end-point occurred in respectively 411, 441 and 163 persons. ST-T changes were associated with all conventional risk factors for CVD except for smoking. For both genders, increasing severity of ST-T changes was significantly associated with increasing CVD mortality (women: HR 1.37 (1.17-1.60) for minor, HR 1.66 (1.41-1.96) for intermediate and HR 2.56 (1.96-3.35) for major changes, p<0.001 and men: HR 1.29 (1.10-1.51) for minor, HR 2.45 (2.10-2.86) for intermediate and HR 2.81 (2.21-3.57), p≤0.001)

Conclusion Regardless of gender, electrocardiographic ST-T changes in persons without known CVD predict poor life-time prognosis among persons without known CVD.