EPICARE, Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University, School of Medicine, Winston-Salem, North Carolina, USA.
Am J Cardiol. 2010 Jul 1;106(1):18-25.e2. doi: 10.1016/j.amjcard.2010.02.007. Epub 2010 May 13.
Electrocardiographic (ECG) Q- and ST-T-wave abnormalities predict coronary heart disease (CHD) and total mortality. No comparison has been made of the classification of these abnormalities by the 2 most widely used ECG coding systems for epidemiologic studies-the Minnesota Code (MC) and Novacode (NC). We evaluated 12-lead electrocardiograms from 64,597 participants (49 to 79 years old, 82% non-Hispanic white) in the Women's Health Initiative clinical trial in 1993 to 1998, with a maximum of 11 years of follow-up. We used MC and NC criteria to identify Q-wave, ST-segment, and T-wave abnormalities for comparison. In total, 3,322 participants (5.1%) died during an average 8-year follow-up, and 1,314 had incident CHD in the baseline cardiovascular disease-free group. Independently, ECG myocardial infarction criteria by the MC or NC were generally equivalent and were strong predictors for CHD death and total mortality (hazard ratio 1.62, 95% confidence interval 1.05 to 2.51 for CHD death; hazard ratio 1.36, 95% confidence interval 1.09 to 1.71 for total mortality) in a multivariable analytic model. Electrocardiograms with major ST-T abnormalities by the MC or NC coding system were stronger in predicting CHD deaths and total mortality than was the presence of Q waves alone. In conclusion, the ECG classification systems for myocardial infarction/ischemia abnormalities from the MC and NC are valuable and useful in clinical trials and epidemiologic studies. ST-T abnormalities are stronger predictors for CHD events and total mortality than isolated Q-wave abnormalities.
心电图（ECG）的 Q 波和 ST-T 波异常可预测冠心病（CHD）和总死亡率。目前还没有比较两种最广泛用于流行病学研究的心电图编码系统——明尼苏达州编码（MC）和 Novacode（NC）——对这些异常的分类。我们评估了 1993 年至 1998 年参加妇女健康倡议临床试验的 64597 名参与者（49 至 79 岁，82%为非西班牙裔白人）的 12 导联心电图，随访时间最长为 11 年。我们使用 MC 和 NC 标准来识别 Q 波、ST 段和 T 波异常进行比较。共有 3322 名参与者（5.1%）在平均 8 年的随访期间死亡，1314 名基线无心血管疾病的参与者发生了 CHD。独立地，MC 或 NC 的心电图心肌梗死标准通常是等效的，并且是 CHD 死亡和总死亡率的强有力预测因素（CHD 死亡的危险比为 1.62，95%置信区间为 1.05 至 2.51；总死亡率的危险比为 1.36，95%置信区间为 1.09 至 1.71）在多变量分析模型中。MC 或 NC 编码系统的主要 ST-T 异常的心电图在预测 CHD 死亡和总死亡率方面比单独存在 Q 波更强。总之，MC 和 NC 的心肌梗死/缺血异常心电图分类系统在临床试验和流行病学研究中具有重要价值和用途。ST-T 异常比孤立的 Q 波异常更能预测 CHD 事件和总死亡率。
