Abstract 14876: The Association of Baseline Elevation at Various ST Points With Mortality in the Multi-Ethnic Study of Atherosclerosis and Atherosclerosis Risk in Communities Study Cohorts
Background: Prior studies suggest that ST elevation at the J-point is associated with elevated risk of death. We sought to examine the prevalence and prognostic importance of elevation at various ST points in a large multi-ethnic population.
Methods and Results: After confirming data harmonization, we combined ECG, demographics, and mortality data for 19,578 participants from the Atherosclerosis Risk in Communities Study (ARIC) and the Multi-ethnic Study of Atherosclerosis (MESA) population-based cohorts. The average age at baseline was 56.1 ± 8.1 years and 56.2% of the participants were female. Participants were stratified by the presence of ≥1 mm inferior (0.5%), lateral (27.8%), inferior or lateral (29.3%), and inferior and lateral (0.2%) ST elevation (at the J-point, mid-point, 60ms after the J-point, and end-point). We utilized models adjusted for age, gender, ethnicity, source cohort, BMI, education, heart rate, hypertension, left ventricular hypertrophy, smoking status, diabetes, LDL, HDL, and aspirin and/or statin therapy. Inferior ST elevation at any ST point was associated with increased mortality (HR 1.94, 95%CI 1.32 – 2.84). In contrast, lateral elevation at any ST point was associated with decreased mortality (HR 0.88, 95%CI 0.81 – 0.95). ST-end elevation was more common and drove the association of lateral elevation with decreased mortality. The magnitude of association between inferior ST elevation and increased mortality was strongest when elevation occurred at the mid-ST or J-points. Although the prevalence of elevation varied among subgroups, no additive or multiplicative interactions were noted with gender or ethnicity.
Conclusions: We found that asymptomatic inferior lead ST elevation is uncommon and is associated with elevated risk of mortality regardless of ethnicity. In contrast, asymptomatic lateral ST elevation at the ST-end point is common and is associated with lower risk of mortality.
Author Disclosures: R.M. Vakil: None. D. Tian: None. Y. Zhang: None. E. Guallar: None. E.Z. Soliman: None. S.R. Heckbert: None. G. Tomaselli: None. W. Post: None. D.A. Bluemke: None. L. Ilkhanoff: None. J. Lima: None. M. Szklo: None. S. Nazarian: Research Grant; Significant; Biosense Webster. Consultant/Advisory Board; Significant; Biosense Webster, CardioSolv, Medtronic.
- © 2016 by American Heart Association, Inc.