Prevalence, prognosis, and implications of isolated minor nonspecific ST-segment and T-wave abnormalities in older adults cardiovascular health study

Anita Kumar, Ronald J. Prineas, Alice M. Arnold, Bruce M. Psaty, Curt D. Furberg, John A Robbins, Donald M. Lloyd-Jones

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Background - The prevalence and prognostic significance of isolated minor nonspecific ST-segment and T-wave abnormalities (NSSTTAs) in older adults are poorly understood. Methods and Results - Cardiovascular Health Study participants free of both clinical cardiovascular disease and major ECG abnormalities were included. We examined the prospective association of isolated minor NSSTTAs (defined by Minnesota Codes 4-3, 4-4, 5-3, and 5-4) with total, cardiovascular, and coronary mortality and incident nonfatal myocardial infarction. Among 3224 participants (61.9% women; mean age, 72 years), 233 (7.2%) had isolated NSSTTAs at baseline. Covariates associated with isolated NSSTTAs included older age, nonwhite race (20.5% of blacks versus 4.8% of whites; P<0.001), diabetes, and higher blood pressure and body mass index but not the presence of subclinical cardiovascular disease. After 39518 person-years of follow-up, the presence of isolated NSSTTAs was associated with significantly increased risk for coronary heart disease mortality (multivariable-adjusted hazards ratio, 1.76; 95% CI, 1.18 to 2.61) but not with incident nonfatal myocardial infarction (multivariable-adjusted hazards ratio, 0.71; 95% CI, 0.43 to 1.17). The association of isolated NSSTTAs with coronary death was independent of subclinical atherosclerosis and left ventricular mass measures. In secondary analyses, among those with cardiac death, there was a significantly higher rate of primary arrhythmic death (32.3% versus 15.4%; P=0.02) in participants with isolated NSSTTAs versus those without NSSTTAs. Conclusions - Isolated NSSTTAs are common in older Americans and are associated with significantly increased risk for coronary death. However, isolated NSSTTAs are not associated with incident nonfatal myocardial infarction, suggesting that they are associated particularly with increased risk for primary arrhythmic death.

Original languageEnglish (US)
Pages (from-to)2790-2796
Number of pages7
JournalCirculation
Volume118
Issue number25
DOIs
StatePublished - Dec 23 2008

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Health
Myocardial Infarction
Cardiovascular Diseases
Mortality
Coronary Disease
Atherosclerosis
Electrocardiography
Body Mass Index
Hypertension

Keywords

  • Death sudden
  • Electrocardiography
  • Epidemiology
  • Myocardial infarction
  • Prognosis
  • Risk

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Prevalence, prognosis, and implications of isolated minor nonspecific ST-segment and T-wave abnormalities in older adults cardiovascular health study. / Kumar, Anita; Prineas, Ronald J.; Arnold, Alice M.; Psaty, Bruce M.; Furberg, Curt D.; Robbins, John A; Lloyd-Jones, Donald M.

In: Circulation, Vol. 118, No. 25, 23.12.2008, p. 2790-2796.

Research output: Contribution to journalArticle

Kumar, Anita ; Prineas, Ronald J. ; Arnold, Alice M. ; Psaty, Bruce M. ; Furberg, Curt D. ; Robbins, John A ; Lloyd-Jones, Donald M. / Prevalence, prognosis, and implications of isolated minor nonspecific ST-segment and T-wave abnormalities in older adults cardiovascular health study. In: Circulation. 2008 ; Vol. 118, No. 25. pp. 2790-2796.
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AU - Kumar, Anita

AU - Prineas, Ronald J.

AU - Arnold, Alice M.

AU - Psaty, Bruce M.

AU - Furberg, Curt D.

AU - Robbins, John A

AU - Lloyd-Jones, Donald M.

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N2 - Background - The prevalence and prognostic significance of isolated minor nonspecific ST-segment and T-wave abnormalities (NSSTTAs) in older adults are poorly understood. Methods and Results - Cardiovascular Health Study participants free of both clinical cardiovascular disease and major ECG abnormalities were included. We examined the prospective association of isolated minor NSSTTAs (defined by Minnesota Codes 4-3, 4-4, 5-3, and 5-4) with total, cardiovascular, and coronary mortality and incident nonfatal myocardial infarction. Among 3224 participants (61.9% women; mean age, 72 years), 233 (7.2%) had isolated NSSTTAs at baseline. Covariates associated with isolated NSSTTAs included older age, nonwhite race (20.5% of blacks versus 4.8% of whites; P<0.001), diabetes, and higher blood pressure and body mass index but not the presence of subclinical cardiovascular disease. After 39518 person-years of follow-up, the presence of isolated NSSTTAs was associated with significantly increased risk for coronary heart disease mortality (multivariable-adjusted hazards ratio, 1.76; 95% CI, 1.18 to 2.61) but not with incident nonfatal myocardial infarction (multivariable-adjusted hazards ratio, 0.71; 95% CI, 0.43 to 1.17). The association of isolated NSSTTAs with coronary death was independent of subclinical atherosclerosis and left ventricular mass measures. In secondary analyses, among those with cardiac death, there was a significantly higher rate of primary arrhythmic death (32.3% versus 15.4%; P=0.02) in participants with isolated NSSTTAs versus those without NSSTTAs. Conclusions - Isolated NSSTTAs are common in older Americans and are associated with significantly increased risk for coronary death. However, isolated NSSTTAs are not associated with incident nonfatal myocardial infarction, suggesting that they are associated particularly with increased risk for primary arrhythmic death.

AB - Background - The prevalence and prognostic significance of isolated minor nonspecific ST-segment and T-wave abnormalities (NSSTTAs) in older adults are poorly understood. Methods and Results - Cardiovascular Health Study participants free of both clinical cardiovascular disease and major ECG abnormalities were included. We examined the prospective association of isolated minor NSSTTAs (defined by Minnesota Codes 4-3, 4-4, 5-3, and 5-4) with total, cardiovascular, and coronary mortality and incident nonfatal myocardial infarction. Among 3224 participants (61.9% women; mean age, 72 years), 233 (7.2%) had isolated NSSTTAs at baseline. Covariates associated with isolated NSSTTAs included older age, nonwhite race (20.5% of blacks versus 4.8% of whites; P<0.001), diabetes, and higher blood pressure and body mass index but not the presence of subclinical cardiovascular disease. After 39518 person-years of follow-up, the presence of isolated NSSTTAs was associated with significantly increased risk for coronary heart disease mortality (multivariable-adjusted hazards ratio, 1.76; 95% CI, 1.18 to 2.61) but not with incident nonfatal myocardial infarction (multivariable-adjusted hazards ratio, 0.71; 95% CI, 0.43 to 1.17). The association of isolated NSSTTAs with coronary death was independent of subclinical atherosclerosis and left ventricular mass measures. In secondary analyses, among those with cardiac death, there was a significantly higher rate of primary arrhythmic death (32.3% versus 15.4%; P=0.02) in participants with isolated NSSTTAs versus those without NSSTTAs. Conclusions - Isolated NSSTTAs are common in older Americans and are associated with significantly increased risk for coronary death. However, isolated NSSTTAs are not associated with incident nonfatal myocardial infarction, suggesting that they are associated particularly with increased risk for primary arrhythmic death.

KW - Death sudden

KW - Electrocardiography

KW - Epidemiology

KW - Myocardial infarction

KW - Prognosis

KW - Risk

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