title: Independent Prognostic Value of Single and Multiple Non-Specific 12-Lead Electrocardiographic Findings for Long-Term Cardiovascular Outcomes: A Prospective Cohort Study.
abstract: OBJECTIVE
  The long-term prognostic effect of non-specific 12-lead electrocardiogram findings is unknown. We aimed to evaluate the cumulative prognostic impact of axial, structural, and repolarization categorical abnormalities on cardiovascular death, independent from traditional risk scoring systems such as the Framingham risk score and the NIPPON DATA80 risk chart.
  
  
  RESULTS
  A total of 16,816 healthy men and women from two prospective, longitudinal cohort studies were evaluated. 3,794 (22.6%) individuals died during a median follow-up of 15 years (range, 2.0-24 years). Hazard ratios for cardiovascular death, all-cause death, coronary death and stroke death were calculated for the cumulative and independent axial, structural, and repolarization categorical abnormalities adjusted for the Framingham risk score and the NIPPON DATA80 risk chart. Individuals with two or more abnormal categories had a higher risk of cardiovascular death after adjustment for Framingham risk score (men: HR 4.27, 95%CI 3.35-5.45; women: HR 4.83, 95%CI 3.76-6.22) and NIPPON DATA80 risk chart (men: HR 2.39, 95%CI 1.87-3.07; women: HR 2.04, 95%CI 1.58-2.64).
  
  
  CONCLUSIONS
  Cumulative findings of axial, structural, and repolarization abnormalities are significant predictors of long-term cardiovascular death in asymptomatic, healthy individuals independent of traditional risk stratification systems.
authors.affiliation: Department of Cardiology, Keio University Hospital, Tokyo, Japan.
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Sawano
authors.affiliation: Department of Cardiology, Keio University Hospital, Tokyo, Japan.
authors.forename: Shun
authors.initials: S
authors.lastname: Kohsaka
authors.affiliation: Department of Preventive Medicine and Public Health, Keio University, Tokyo, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Okamura
authors.affiliation: Department of Cardiology, Keio University Hospital, Tokyo, Japan.
authors.forename: Taku
authors.initials: T
authors.lastname: Inohara
authors.affiliation: Department of Preventive Medicine and Public Health, Keio University, Tokyo, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Sugiyama
authors.affiliation: Department of Cardiology, Keio University Hospital, Tokyo, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Shiraishi
authors.affiliation: Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: Department of Cardiovascular Epidemiology, Kyoto Women's University, Kyoto, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Nakamura
authors.affiliation: Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Osaka, Japan.
authors.forename: Aya
authors.initials: A
authors.lastname: Higashiyama
authors.affiliation: Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan.
authors.forename: Aya
authors.initials: A
authors.lastname: Kadota
authors.affiliation: Department of Health and Nutrition, University of Human Arts and Sciences, Saitama, Japan.
authors.forename: Nagako
authors.initials: N
authors.lastname: Okuda
authors.affiliation: Department of Medical Statistics, Toho University School of Medicine, Tokyo, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Murakami
authors.affiliation: Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Ohkubo
authors.affiliation: Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan.|Department of Health Science, Shiga University of Medical Science, Otsu, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Fujiyoshi
authors.affiliation: Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan.|Department of Health Science, Shiga University of Medical Science, Otsu, Japan.
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Miura
authors.affiliation: Research Institute for lifestyle-related disease prevention, Tokyo, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Okayama
authors.affiliation: Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan.|Department of Health Science, Shiga University of Medical Science, Otsu, Japan.
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Ueshima
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000503:physiopathology; D002319:Cardiovascular System / Q000503:physiopathology*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies