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[Major abnormalities of the electrocardiogram and cardiovascular risk in a medium and high-risk Mediterranean
Joan Pou Bordoy1, Alfonso Leiva2, Maria José Albendín Ariza3
1Centre de Salut de Camp Redó, Gerència d'Atenció Primària de Mallorca, Servei de Salut de les Illes Balears (IB-SALUT), Mallorca, Islas Baleares, España; Institut d'Investigació Sanitària de les Illes Balears (IdISBa), Mallorca, Islas Baleares, España.
Insights
Major electrocardiogram abnormalities (MECG) are common and independently predict cardiovascular events (CVE). However, MECG did not improve risk prediction beyond established cardiovascular risk factors (CVRF) in this study.
Area of Science:
- Cardiology
- Preventive Medicine
- Electrocardiography
Background:
- Major electrocardiogram abnormalities (MECG) are prevalent in middle-aged and older adults.
- MECG may serve as a significant predictor of cardiovascular events (CVE).
Purpose of the Study:
- To investigate the association between MECG (Minnesota classification) and CVE, independent of traditional cardiovascular risk factors (CVRF).
- To determine if MECG enhances cardiovascular risk prediction using the Spanish Coronary Event Risk Function (FRESCO).
Main Methods:
- Analysis of 1,752 participants (aged 55-80) from the PREDIMED study with medium to high CVRF.
- Mean follow-up of 5.1 years, assessing cumulative CVE incidence and hazard ratios by sex.
- Utilized multivariate Cox regressions and statistical measures including Harrel's C Indices and reclassification improvements.
Main Results:
- 25% of participants exhibited MECG at baseline.
- MECG showed a significant association with the occurrence of CVE.
- Specific MECG findings like LVH, atrial fibrillation, and ST-segment depression were linked to increased CVE risk in men and women, respectively.
Conclusions:
- MECG are independently associated with cardiovascular events.
- MECG do not significantly improve cardiovascular risk prediction when traditional risk factors are considered.
Introduction:
Major electrocardiogram abnormalities (MECG) are common in middle-aged and older individuals and could be an important factor in predicting cardiovascular events.
Objective:
To analyse the association between MECG (Minnesota classification) and CVE independently of classic cardiovascular risk factors (CVRF), and to assess whether they improve the prediction according to the Spanish Coronary Event Risk Function (FRESCO).
Method:
1.752 participants included in three nodes of the PREDIMED study aged between 55 and 80 years with medium or high CVRF. Mean follow-up time was 5.1 years. Cumulative CVE incidence was estimated by sex with and without MECG, and hazard ratios by sex were estimated using multivariate Cox regressions adjusted for randomization group and CCRF (FRESCO). Harrel's C Indices, Nam d'Agostino, Net Reclassification Improvement, and Integrated Discrimination Improvement were calculated.
Results:
At baseline, 25% of the participants shows major electrocardiogram abnormalities (AMECG). During follow-up, there were 112 cardiovascular events (16 cardiovascular deaths, 15 acute myocardial infarctions, 38 anginas, 43 strokes). MECG were significantly associated with the onset of CVE. In men, left ventricular hypertrophy (LVH) criteria were associated with T-wave inversion (HR: 17.88, 95% CI: 5.51-58.03, pvalor<.001) and QT interval prolongation (HR: 2.41, 95% CI: 1.38-4.21, pvalor=.002); in women, atrial fibrillation (HR: 5.7, 95% CI: 1.76-18.72, pvalor=.006) and ST-segment depression (HR: 3.24, 95% CI: 1.36-7.71, pvalor<.001) were associated. No significant improvement in MECG prediction compared to FRESCO was observed.
Conclusions:
MECG are independently associated with the occurrence of CVE, but do not improve risk prediction beyond traditional risk factors.
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