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A simplified clinical electrocardiogram score for the prediction of cardiovascular mortality
Swee Yaw Tan1, Gannon W Sungar, Jonathan Myers
1Stanford University School of Medicine, Cardiovascular Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA.
Insights
A simple electrocardiogram (ECG) score, by counting classical abnormalities, effectively predicts cardiovascular (CV) mortality. This accessible tool enhances ECGs for clinical prognostic use.
Area of Science:
- Cardiology
- Medical Informatics
- Public Health
Background:
- Electrocardiogram (ECG) scores can predict cardiovascular (CV) mortality.
- Clinical utilization of ECG-based prognostic scores is currently limited.
Purpose of the Study:
- To develop a straightforward scoring system using classical ECG abnormalities.
- To enhance the ECG's utility as a convenient prognostic tool.
Main Methods:
- Analysis of resting ECGs from 29,320 male veterans (1987-2000).
- Inclusion of 12 classic ECG abnormalities based on prevalence and risk.
- Development of a summation score and Cox proportional hazards analysis.
Main Results:
- A graded increase in mortality risk correlated with the number of ECG abnormalities.
- Relative risks for 1-5+ abnormalities ranged from 1.8 to 6.0 (p < 0.001).
- Five or more abnormalities yielded an age-adjusted hazard ratio of 6.0 for CV mortality.
Conclusions:
- Summating classical ECG abnormalities is a potent predictor of CV mortality.
- This scoring method is independent of age, clinical status, and standard risk factors.
Background:
Electrocardiogram (ECG) scores have been demonstrated to predict CV mortality but they are rarely utilized clinically.
Objective:
Develop a simple score consisting of adding classical ECG abnormalities to make the ECG a more convenient prognostic tool.
Methods:
Resting ECGs of 29,320 outpatient male veterans from the Palo Alto Veteran Affairs Healthcare System (PAVHS) collected between 1987 and 2000 were computer analyzed with an average follow-up of 7.5 y. Twelve classic ECG abnormalities were chosen on the basis of prevalence and corresponding relative risks, including left and right bundle branch block, diagnostic Q waves, intraventricular conduction defect, atrial fibrillation, left atrial abnormality, left and right axis deviation, left and right ventricular hypertrophy, ST depression, and abnormal QTc interval. A simple score derived from the summation of these criteria was then entered into an age and heart rate adjusted Cox analysis.
Results:
There was a progressive increase in risk of death as the number of ECG abnormalities increased. The relative risks for 1, 2, 3, 4, and 5 ECG abnormalities were 1.8 (CI 1.6-2.0), 2.4 (CI 2.2-2.7), 3.6 (CI 3.2-4.1), 4.5 (CI 3.8-5.4), and 6.0 (CI 4.7-7.8) respectively (p < 0.001). The age-adjusted hazard ratio for CV mortality was 6.0 when there were five or more ECG abnormalities present.
Conclusion:
Summing the number of classical ECG abnormalities provides a powerful predictor of CV mortality independent of age, standard risk factors, and clinical status.
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