Association of nonspecific minor ST-T abnormalities with cardiovascular mortality: the Chicago Western Electric Study.

CONTEXT Minor electrocardiographic (ECG) ST-T abnormalities are common, but their prognostic importance has not been fully determined. OBJECTIVE To examine associations of single (1 time only) and multiple (2 times only and > or =3 times) nonspecific minor ST-T abnormalities in 5 years with long-term mortality due to myocardial infarction (MI), coronary heart disease (CHD), cardiovascular disease (CVD), and all causes in middle-aged men. DESIGN Prospective cohort study (29-year follow-up after 5 annual examinations). SETTING AND PARTICIPANTS A total of 1673 men employed at the Western Electric Company in Chicago, III, aged 40 to 55 years at entry, with no evidence of CHD and no major ECG abnormalities throughout the first 5-year period. MAIN OUTCOME MEASURES Minor ST-T abnormalities identified from annual resting ECGs and mortality ascertained from death certificates. RESULTS Of the 1673 men, 173 had evidence of isolated nonspecific minor ST-T segment abnormalities. During the follow-up period, there were 234 deaths due to MI, 352 deaths due to CHD, 463 deaths due to CVD, and 889 deaths due to all causes. For men with 3 or more annual recordings of minor ST-T abnormalities, risk of death due to MI, CHD, CVD, and all causes was significantly greater than for those with normal ECG findings. For men with 3 or more ECGs with minor ST-T abnormalities, relative risks (and 95% confidence intervals) adjusted for cardiovascular and other risk factors were 2.28 (1.16-4.49), 2.39 (1.39-4.12), 2.30 (1.44-3.68), and 1.60 (1.06-2.42), respectively, with a graded relationship between frequency of occurrence of ST-T abnormalities and mortality risk (linear trend, P< or =.007). CONCLUSIONS Persistent, minor, nonspecific ST-T abnormalities are associated with increased long-term risk of mortality due to MI, CHD, CVD, and all causes; the higher the frequency of occurrence of minor ST-T abnormalities, the greater the risk. These data underscore the potential value of including nonspecific ECG findings in the overall assessment of cardiovascular risk.

[1]  G. Thorgeirsson,et al.  Silent ST-T changes in an epidemiologic cohort study--a marker of hypertension or coronary heart disease, or both: the Reykjavik study. , 1996, Journal of the American College of Cardiology.

[2]  D. De Bacquer,et al.  The predictive value of electrocardiographic abnormalities for total and cardiovascular disease mortality in men and women. , 1994, European heart journal.

[3]  Kannel Wb,et al.  A new approach for estimating healthy body weights. , 1993 .

[4]  R. Garrison,et al.  A new approach for estimating healthy body weights. , 1993, International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity.

[5]  J. Stamler.  Blood pressure and high blood pressure. Aspects of risk. , 1991, Hypertension.

[6]  D. Reed,et al.  The predictive value of resting electrocardiograms for 12-year incidence of coronary heart disease in the Honolulu Heart Program. , 1988, Journal of clinical epidemiology.

[7]  K. Anderson,et al.  Nonspecific electrocardiographic abnormality as a predictor of coronary heart disease: the Framingham Study. , 1987, American heart journal.

[8]  A. Dyer,et al.  Sex differential in the relationship of electrocardiographic ST-T abnormalities to risk of coronary death: 11.5 year follow-up findings of the Chicago Heart Association Detection Project in Industry. , 1987, Circulation.

[9]  S. Rabkin,et al.  The electrocardiogram in apparently healthy men and the risk of sudden death. , 1982, British heart journal.

[10]  N. Stenhouse,et al.  Electrocardiograms and 13 year cardiovascular mortality in Busselton study. , 1982, British heart journal.

[11]  R. B. Singer,et al.  Mortality in 4100 insured applicants with ECG and chest X-ray: relation to cardiovascular and other risk factors, including relative heart diameter. , 1982, Transactions of the Association of Life Insurance Medical Directors of America.

[12]  Ronald J. Prineas,et al.  The Minnesota code manual of electrocardiographic findings : standards and procedures for measurement and classification , 1982 .

[13]  J. Atterhög.  A 5-year follow-up of young men with primary T wave aberrations in their electrocardiograms. , 2009, Acta medica Scandinavica.

[14]  P. Schnohr,et al.  Electrocardiographic findings and their association with mortality in the Copenhagen City Heart Study. , 1981, European heart journal.

[15]  A prospective study of the development of coronary heart disease in a group of 1202 middle-aged men. , 1980, Journal of epidemiology and community health.

[16]  P. Baxter,et al.  Prevalence and prognosis of electrocardiographic findings in middle-aged men. , 1978, British heart journal.

[17]  A. Reunanen,et al.  Predictive value of ECG findings with respect to coronary heart disease mortality. , 1978, Advances in cardiology.

[18]  C. Pepine,et al.  Transient asymptomatic S-T segment depression during daily activity. , 1977, The American journal of cardiology.

[19]  F. Magrini,et al.  Stress-induced and sympathetically-mediated electrocardiographic and circulatory variations in the primary hyperkinetic heart syndrome. , 1975, Cardiovascular research.

[20]  The prognostic importance of the electrocardiogram after myocardial infarction. Experience in the Coronary Drug Project. , 1972, Annals of internal medicine.

[21]  H. Tyroler,et al.  Electrocardiographic predictors of coronary heart disease. , 1971 .

[22]  A. Keys,et al.  XVI. The Electrocardiogram in Prediction of Five‐Year Coronary Heart Disease Incidence Among Men Aged Forty through Fifty‐Nine , 1970, Circulation.

[23]  L. Ostrander,et al.  The relation of "silent" T wave inversion to cardiovascular disease in an epidemiologic study. , 1970, American Journal of Cardiology.

[24]  A. Steinberg,et al.  Electrocardiographic Findings Among the Total Adult Population of a Large Religious Isolate , 1970, Circulation.

[25]  W. Kannel,et al.  Left ventricular hypertrophy by electrocardiogram. Prevalence, incidence, and mortality in the Framingham study. , 1969, Annals of internal medicine.

[26]  M. Ellestad,et al.  The significance of hyperventilative and orthostatic T-wave changes on the electrocardiogram. , 1968, Archives of internal medicine.

[27]  C. Furberg,et al.  Adrenergic beta-blockade and electrocardiographical ST-T changes. , 2009, Acta medica Scandinavica.

[28]  A. Graybiel,et al.  SERIAL ELECTROCARDIOGRAMS: THEIR RELIABILITY AND PROGNOSTIC VALIDITY OVER A 24-YEAR PERIOD, , 1967 .

[29]  A. Graybiel,et al.  Serial electrocardiograms: their reliability and prognostic validity during a 24-yr. period. , 1967, Journal of chronic diseases.

[30]  L. Ostrander,et al.  Serial Electrocardiographic Findings in a Prospective Epidemiological Study , 1966, Circulation.

[31]  F. Epstein,et al.  Electrocardiographic Findings Among the Adult Population of a Total Natural Community, Tecumseh, Michigan , 1965, Circulation.

[32]  W. Kannel,et al.  The Electrocardiogram in Epidemiological Studies , 1965, British journal of preventive & social medicine.

[33]  C. E. Kiessling,et al.  A STUDY OF T WAVE CHANGES IN THE ELECTROCARDIOGRAMS OF NORMAL INDIVIDUALS. , 1964, The American journal of cardiology.

[34]  W. H. Phelan,et al.  A Longitudinal Study of Coronary Heart Disease , 1963, Circulation.

[35]  H. Ungerleider.  The prognostic implications of the electrocardiogram. , 1960, The American journal of cardiology.

[36]  F. A. Mathewson,et al.  Abnormal Electrocardiograms in Apparently Healthy People: I. Long Term Follow‐up Study , 1960, Circulation.

[37]  D.,et al.  Regression Models and Life-Tables , 2022 .