A simplified clinical electrocardiogram score for the prediction of cardiovascular mortality.
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.


CONCLUSIONS
Summing the number of classical ECG abnormalities provides a powerful predictor of CV mortality independent of age, standard risk factors, and clinical status.
Tan
Swee Yaw
SY
Stanford University School of Medicine, Cardiovascular Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA.
Sungar
Gannon W
GW
Myers
Jonathan
J
Sandri
Marcus
M
Froelicher
Victor
V
D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000503:physiopathology; D016001:Confidence Intervals; D004562:Electrocardiography / Q000379:methods*; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012306:Risk; D018570:Risk Assessment; D012307:Risk Factors; D014728:Veterans