title: Association of major and minor ECG abnormalities with coronary heart disease events.
abstract: BACKGROUND
  In populations of older adults, prediction of coronary heart disease (CHD) events through traditional risk factors is less accurate than in middle-aged adults. Electrocardiographic (ECG) abnormalities are common in older adults and might be of value for CHD prediction.
  
  
  OBJECTIVE
  To determine whether baseline ECG abnormalities or development of new and persistent ECG abnormalities are associated with increased CHD events.
  
  
  METHODS
  A population-based study of 2192 white and black older adults aged 70 to 79 years from the Health, Aging, and Body Composition Study (Health ABC Study) without known cardiovascular disease. Adjudicated CHD events were collected over 8 years between 1997-1998 and 2006-2007. Baseline and 4-year ECG abnormalities were classified according to the Minnesota Code as major and minor. Using Cox proportional hazards regression models, the addition of ECG abnormalities to traditional risk factors were examined to predict CHD events.
  
  
  METHODS
  Adjudicated CHD events (acute myocardial infarction [MI], CHD death, and hospitalization for angina or coronary revascularization).
  
  
  RESULTS
  At baseline, 276 participants (13%) had minor and 506 (23%) had major ECG abnormalities. During follow-up, 351 participants had CHD events (96 CHD deaths, 101 acute MIs, and 154 hospitalizations for angina or coronary revascularizations). Both baseline minor and major ECG abnormalities were associated with an increased risk of CHD after adjustment for traditional risk factors (17.2 per 1000 person-years among those with no abnormalities; 29.3 per 1000 person-years; hazard ratio [HR], 1.35; 95% CI, 1.02-1.81; for minor abnormalities; and 31.6 per 1000 person-years; HR, 1.51; 95% CI, 1.20-1.90; for major abnormalities). When ECG abnormalities were added to a model containing traditional risk factors alone, 13.6% of intermediate-risk participants with both major and minor ECG abnormalities were correctly reclassified (overall net reclassification improvement [NRI], 7.4%; 95% CI, 3.1%-19.0%; integrated discrimination improvement, 0.99%; 95% CI, 0.32%-2.15%). After 4 years, 208 participants had new and 416 had persistent abnormalities. Both new and persistent ECG abnormalities were associated with an increased risk of subsequent CHD events (HR, 2.01; 95% CI, 1.33-3.02; and HR, 1.66; 95% CI, 1.18-2.34; respectively). When added to the Framingham Risk Score, the NRI was not significant (5.7%; 95% CI, -0.4% to 11.8%).
  
  
  CONCLUSIONS
  Major and minor ECG abnormalities among older adults were associated with an increased risk of CHD events. Depending on the model, adding ECG abnormalities was associated with improved risk prediction beyond traditional risk factors.
authors.affiliation: Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland. reto.auer@ucsf.edu
authors.forename: Reto
authors.initials: R
authors.lastname: Auer
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Bauer
authors.forename: Pedro
authors.initials: P
authors.lastname: Marques-Vidal
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.forename: Lauren J
authors.initials: LJ
authors.lastname: Min
authors.forename: Jacques
authors.initials: J
authors.lastname: Cornuz
authors.forename: Suzanne
authors.initials: S
authors.lastname: Satterfield
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
authors.forename: Eric
authors.initials: E
authors.lastname: Vittinghoff
authors.forename: Nicolas
authors.initials: N
authors.lastname: Rodondi
mesh_terms: D000368:Aged; D003327:Coronary Disease / Q000453:epidemiology*; D004562:Electrocardiography / Q000145:classification*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010414:Pennsylvania / Q000453:epidemiology; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D013714:Tennessee / Q000453:epidemiology