T-wave abnormalities are a better predictor of cardiovascular mortality than ST depression on the resting
James Beckerman1, Takuya Yamazaki, Jonathan Myers
1Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA, USA.
Insights
T-wave abnormalities are stronger predictors of cardiovascular death than ST depression. This study compared both ECG findings, revealing T-wave changes indicate higher mortality risk.
Area of Science:
- Cardiology
- Electrocardiography
- Predictive Medicine
Background:
- ST depression and T-wave abnormalities are established independent predictors of cardiovascular death.
- A direct comparative analysis of their predictive power for cardiovascular mortality has not been previously described.
Purpose of the Study:
- To directly compare the prognostic value of ST depression versus T-wave abnormalities for predicting cardiovascular death.
- To determine which electrocardiogram (ECG) finding, ST depression or T-wave abnormality, is a greater predictor of cardiovascular mortality.
Main Methods:
- Analysis of 31,074 male patients' initial electrocardiograms (ECGs) from the Palo Alto Veterans Affairs Medical Center.
- Exclusion of females and patients with specific ECG findings like bundle branch block or Wolff-Parkinson-White syndrome.
- Classification of ECGs using the Minnesota code to assess ST depression and T-wave abnormalities, analyzing nine combinations.
Main Results:
- The combination of major ST segment and T-wave abnormalities presented the highest hazard ratio for cardiovascular death (3.2).
- Minor ST depression with severe T-wave abnormalities showed a hazard ratio of 3.1.
- Minor T-wave abnormalities with severe ST depression had a lower hazard ratio of 1.9.
Conclusions:
- Both ST segment depression and T-wave abnormalities are significant predictors of cardiovascular mortality.
- T-wave abnormalities appear to be a more potent predictor of cardiovascular mortality compared to ST segment depression.
Background:
ST depression and T-wave amplitude abnormalities are known to be independent predictors of cardiovascular (CV) death, but a direct comparison between them has not been described.
Methods:
Analyses were performed on the first electrocardiogram (ECG) digitally recorded on 46,950 consecutive patients at the Palo Alto Veterans Affairs Medical Center since 1987. Females and patients with electrocardiograms exhibiting bundle branch block, left ventricular hypertrophy, electronic pacing, diagnostic Q waves, or Wolff-Parkinson-White syndrome were excluded, leaving 31,074 male patients for analysis (mean age 55 +/- 14). There were 1878 (6.0%) cardiovascular deaths (mean follow-up of 6 +/- 4 years). Electrocardiograms were classified using Minnesota code according to the degree of ST depression and T-wave abnormality, and the nine possible combinations of ST segment and T-wave abnormalities were recoded for analysis.
Results:
The combination of major abnormalities in ST segments and T-waves carried the greatest hazard [3.2 (CI 2.7-3.8)]. Minor ST depression combined with more severe T-wave abnormalities carried a hazard of 3.1 (CI 2.5-3.7), whereas minor T-wave abnormalities combined with more severe ST depression carried a hazard of only 1.9 (CI 1.6-2.3).
Conclusion:
While both ST segment depression and abnormal T-wave amplitude are clinically important, T-wave abnormalities appear to be greater predictors of cardiovascular mortality.
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