University of Miami, Miller School of Medicine, Miami, Florida, USA.
Am J Cardiol. 2012 Aug 15;110(4):521-5. doi: 10.1016/j.amjcard.2012.04.023. Epub 2012 May 18.
Most clinicians regard isolated, minor, or nonspecific ST-segment and T-wave (NS-STT) abnormalities to be incidental, often transient, and benign findings in asymptomatic patients. We sought to evaluate whether isolated NS-STT abnormalities on routine electrocardiograms (ECGs) are associated with increased risk of cardiovascular mortality (CM) and all-cause mortality (AM) in a cross-sectional United States population without known coronary artery disease. We included all adults 40 to 90 years of age without known coronary artery disease or risk equivalent based on history and laboratory values, enrolled in the NHANES III from 1988 to 1994, with electrocardiographic data available, and a total follow-up period of 59,781.75 patient-years. NS-STT abnormalities were defined by Minnesota Coding. Subjects were excluded if their mortality data were missing or if they had major electrocardiographic abnormalities, heart rate >120 beats/min, nonsinus rhythm, cardiac infarction/injury score ≥ 20 on ECG, left ventricular hypertrophy by Minnesota Codes 3.1 and 3.3, or patient-reported history coronary artery disease, congestive heart failure, stroke, diabetes, or peripheral arterial disease. The remaining 4,426 subjects were stratified by presence or absence of NS-STT abnormalities. Mortality was judged based on International Classification of Diseases, Tenth Revision coding linked to the National Death Index. Cox proportional hazard ratio was used for multivariate analysis, showing that CM (hazards ratio 1.71, 95% confidence interval 1.04 to 2.83, p = 0.04) and AM (hazards ratio 1.37, 95% confidence interval 1.03 to 1.81, p = 0.02) were significantly higher in the isolated NS-STT abnormalities group. In conclusion, isolated NS-STT abnormalities on ECG were associated with a higher incidence of CM and AM in this large nationally representative cross-sectional cohort without known coronary artery disease or coronary artery disease risk equivalents.
大多数临床医生认为孤立的、轻微的或非特异性的 ST 段和 T 波（NS-STT）异常是无症状患者中偶然出现的、通常是短暂的、良性的发现。我们试图评估在没有已知冠状动脉疾病的美国横断面人群中，常规心电图（ECG）上孤立的 NS-STT 异常是否与心血管死亡率（CM）和全因死亡率（AM）风险增加相关。我们纳入了所有年龄在 40 至 90 岁之间、无已知冠状动脉疾病或病史和实验室检查值相当于冠状动脉疾病风险的成年人，这些人参加了 1988 年至 1994 年的 NHANES III 研究，可获得心电图数据，总随访时间为 59781.75 患者年。NS-STT 异常由明尼苏达编码定义。如果患者的死亡率数据缺失或存在主要心电图异常、心率>120 次/分、非窦性节律、心电图上的心肌梗死/损伤评分≥20、明尼苏达编码 3.1 和 3.3 下的左心室肥厚或患者报告的冠状动脉疾病、充血性心力衰竭、中风、糖尿病或外周动脉疾病史，则将其排除在外。剩余的 4426 名患者按是否存在 NS-STT 异常进行分层。根据与国家死亡索引相关联的国际疾病分类，第十次修订版编码来判断死亡率。使用 Cox 比例风险比进行多变量分析，结果表明，CM（风险比 1.71，95%置信区间 1.04 至 2.83，p=0.04）和 AM（风险比 1.37，95%置信区间 1.03 至 1.81，p=0.02）在孤立的 NS-STT 异常组中显著更高。总之，在这个没有已知冠状动脉疾病或冠状动脉疾病风险等同物的大型全国代表性横断面队列中，心电图上孤立的 NS-STT 异常与 CM 和 AM 的发生率增加相关。
