Association between corrected QT interval and long-term cardiovascular outcomes in elderly patients who had undergone
Yao-Ting Chang1, I-Shiang Tzeng2, Shih-Jung Jang1,3
1Division of Cardiology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.
Insights
Prolonged corrected QT (QTc) intervals are linked to higher risks of death and major adverse cardiovascular events (MACE) in elderly patients with symptomatic lower extremity arterial disease (LEAD). This highlights QTc interval as a significant predictor of poor outcomes.
Area of Science:
- Cardiology
- Vascular Medicine
- Electrocardiography
Background:
- Prolonged corrected QT (QTc) intervals are associated with increased cardiovascular risk.
- Limited data exist on QTc interval's impact on cardiovascular outcomes in patients with lower extremity arterial disease (LEAD).
Purpose of the Study:
- To investigate the association between QTc interval duration and long-term cardiovascular outcomes in elderly patients with symptomatic atherosclerotic LEAD.
Main Methods:
- A cohort study of 504 elderly patients with atherosclerotic LEAD undergoing endovascular therapy was conducted.
- Data were analyzed using Cox proportional hazard models and Kaplan-Meier analysis.
- The study examined associations with all-cause mortality and major adverse cardiovascular events (MACE).
Main Results:
- A longer QTc interval was significantly associated with increased risks of all-cause mortality (HR 1.49) and MACE (HR 1.59).
- Five-year mortality and MACE rates were significantly higher in higher QTc interval terciles.
- QTc interval and C-reactive protein levels showed a strong interaction associated with mortality and MACE.
Conclusions:
- In elderly patients with symptomatic atherosclerotic LEAD, a prolonged QTc interval predicts increased mortality and MACE.
- QTc interval is a valuable prognostic marker in this patient population.
- The findings underscore the importance of monitoring QTc interval in LEAD patients.
Background:
Population-based studies have reported the association between prolonged corrected QT (QTc) intervals and an increased risk of adverse cardiovascular events. Data regarding the association between longer QTc intervals and incident cardiovascular outcomes in patients with lower extremity arterial disease (LEAD) are scarce.
Objective:
To examine the impact of QTc interval on long-term cardiovascular outcomes in elderly patients with symptomatic LEAD.
Methods:
This cohort study extracted data from the Tzu-chi Registry of ENDovascular Intervention for Peripheral Artery Disease (TRENDPAD) and enrolled 504 patients aged ≥ 70 treated with endovascular therapy for atherosclerotic LEAD from July 1, 2005, to December 31, 2019. The main outcomes of interest were all-cause mortality and major adverse cardiovascular events (MACE). Multivariate analysis was conducted using the Cox proportional hazard model to determine independent variables. We performed interaction analysis between corrected QT and other covariates and Kaplan-Meier analysis to compare the outcome of interest among the groups stratified by the tercile of QTc intervals.
Results:
A total of 504 patients [235 men (46.6%); mean age, 79.9 ± 6.2 years; mean QTc interval, 459 ± 33 msec] entered the final data analysis. We categorized the baseline patient characteristics according to terciles of QTc intervals. During the median follow-up time of 3.15 (interquartile ranges, 1.65-5.42) years, we noted 264 deaths and 145 MACEs. The 5-year rates of freedom from all-cause mortality (71% vs. 57% vs. 31%, P < 0.001) and MACEs (83% vs. 67% vs. 46%, P < 0.001) were significantly different among the tercile groups. Multivariate analysis showed that a 1-SD increase in the QTc interval increased the risk of all-cause mortality [hazard ratio (HR) 1.49, P < 0.001] and MACEs (HR 1.59, P < 0.001) after adjusting for other covariates. The interaction analysis showed that QTc interval and C-reactive protein levels were most strongly associated with death (HR = 4.88, 95% CI 3.09-7.73, interaction P < 0.001) and MACEs (HR = 7.83, 95% CI 4.14-14.79, interaction P < 0.001).
Conclusions:
In elderly patients with symptomatic atherosclerotic LEAD, a prolonged QTc interval is associated with advanced limb ischemia, multiple medical comorbidities, increased risk of MACEs, and all-cause mortality.
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