Association between resting painless ST-segment depression with sudden cardiac death in middle-aged population: A
Xue-Qiong Deng1, Xiong-Jun Xu2, Su-Hua Wu1
1Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China.
Insights
Painless ST-segment depression (STD) on an electrocardiogram is a significant predictor of future sudden cardiac death (SCD) in the general population. This finding highlights the importance of recognizing silent STD for cardiovascular risk assessment.
Area of Science:
- Cardiology
- Preventive Medicine
- Epidemiology
Background:
- Electrocardiographic ST changes, even silent ones, can predict future coronary heart disease (CHD).
- The prognostic value of painless ST-segment depression (STD) for sudden cardiac death (SCD) in individuals without diagnosed CHD remains unclear.
- This study investigated the association between non-ischemic resting STD and SCD risk in the general population.
Purpose of the Study:
- To determine if resting painless ST-segment depression (STD) is an independent predictor of sudden cardiac death (SCD).
- To assess the risk of SCD associated with different magnitudes of STD in a general middle-aged population.
- To explore potential interactions of STD with gender and race in predicting SCD.
Main Methods:
- Analysis of 14,935 middle-aged subjects from the prospective Atherosclerosis Risk in Communities (ARIC) study.
- Use of Cox models to estimate hazard ratios (HRs) adjusted for confounding factors.
- Definition of STD as ST-segment depression of ≥0.05 mV in two or more contiguous leads.
Main Results:
- A total of 626 SCD events occurred during a mean follow-up of 20.4 years.
- Resting painless STD (≥0.05 mV) significantly increased SCD risk (adjusted HR, 1.45).
- Higher STD magnitude (≥0.1 mV) showed an even greater SCD risk (adjusted HR, 1.90), with significant interactions by gender and race. STD predicted SCD in males and whites, particularly in lateral and global leads.
Conclusions:
- Resting painless ST-segment depression is an independent predictor of sudden cardiac death.
- This risk is present in the middle-aged population even without previously diagnosed coronary heart disease.
- Identifying silent STD is crucial for cardiovascular risk stratification.
Backgound:
Silent electrocardiographic ST change predicts future coronary heart disease (CHD) incidence and mortality, but the prognostic significance of painless ST-segment depression (STD) with respect to sudden cardiac death (SCD) in subjects without apparent CHD remain unclear. This study sought to test the association between non-ischemic resting STD and risk of SCD in the general population.
Methods:
A total of 14,935 middle-aged subjects from the prospective, population-based Atherosclerosis Risk in Communities (ARIC) study were included in this analysis. Cox models were used to estimate the hazard ratios (HRs) adjusted for possible confounding factors. STD was defined as ST-segment depression of ≥0.05 mV in two or more contiguous leads.
Results:
A total of 626 sudden cardiac death occurred during the mean follow-up of 20.4 years. Compared with those without STD, subjects with resting painless STD of at least 0.05 mV had a significantly increased risk of developing SCD (adjusted HR, 1.45; 95% CI, 1.20 to 1.76), and those with STD ≥ 0.1 mV had even higher risk of SCD (adjusted HR, 1.90; 95% CI, 1.25 to 2.88). Significant interactions were present between gender and STD (P = .03), and between race and STD (P = .01). STD was significantly predictive of SCD in males (adjusted HR, 1.57; 95% CI, 1.22-2.01) and in whites (adjusted HR, 1.65; 95% CI, 1.27-2.14). STD in lateral leads and global leads were strong predictors of SCD.
Conclusions:
Resting painless STD was an independent predictor of SCD in the middle-aged population without previously diagnosed CHD.
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