Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, Republic of Korea.
Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri City, Republic of Korea.
Ann Med. 2020 Aug;52(5):215-224. doi: 10.1080/07853890.2020.1755052. Epub 2020 Apr 28.
We investigated the predictive values of myocardial injury-related findings (MIFs) including ST-T wave abnormalities (STA) and pathologic Q waves (PQ) in electrocardiography for long-term cardiovascular outcomes in an asymptomatic general population. We observed 8444 subjects without cardiovascular diseases and related symptoms biennially over a 12-year period. Major cardiovascular adverse events (MACEs) were defined as a composite of cardiovascular death, myocardial infarction, coronary artery disease and stroke. MACEs occurred more frequently in subjects with STA (9.1% vs. 5.2%, < .001) and in those with anterior PQ (11.5% vs. 5.2%, = .001) than in those without any MIFs, whereas anterolateral/posterior PQ were not associated with a higher incidence of MACEs. Multivariate Cox regression analyses showed that STA and anterior PQ were independently associated with the risk of MACEs. However, survival receiver operating characteristic curve analysis showed that the composite of STA and anterior PQ did not improve the predictive power of the conventional cardiovascular risk estimators when added to the models. The presence of STA or anterior PQ was associated with worse cardiovascular outcomes in the asymptomatic general population. However, the addition of MIFs to the conventional risk estimators was of limited value in the prediction of MACEs.Key MessagesMyocardial injury-related findings including ST-T wave abnormalities and anterior pathologic Q waves in resting electrocardiography predict long-term cardiovascular outcomes in an asymptomatic low-risk population.However, ST-T wave abnormalities and anterior pathologic Q waves add only limited value to conventional cardiovascular risk estimators in the prediction of cardiovascular outcomes.
我们研究了包括心电图 ST-T 波异常（STA）和病理性 Q 波（PQ）在内的心肌损伤相关发现（MIFs）对无症状普通人群长期心血管结局的预测价值。我们观察了 8444 名无心血管疾病和相关症状的受试者，随访时间为 12 年，每两年一次。主要心血管不良事件（MACEs）定义为心血管死亡、心肌梗死、冠心病和中风的综合事件。与无任何 MIFs 的受试者相比，存在 STA（9.1% vs. 5.2%，<.001）和前 PQ（11.5% vs. 5.2%，=.001）的受试者发生 MACEs的频率更高，而前侧壁/后 PQ 与更高的 MACEs发生率无关。多变量 Cox 回归分析显示，STA 和前 PQ 与 MACEs 的风险独立相关。然而，生存接收器操作特征曲线分析表明，当添加到模型中时，STA 和前 PQ 的组合并不能提高传统心血管风险评估器的预测能力。STA 或前 PQ 的存在与无症状普通人群心血管结局较差相关。然而，将 MIFs 加入到传统风险评估器中对 MACEs 的预测价值有限。
关键信息
静息心电图中的心肌损伤相关发现，包括 ST-T 波异常和前病理性 Q 波，可预测无症状低危人群的长期心血管结局。
然而，ST-T 波异常和前病理性 Q 波在预测心血管结局方面，仅对传统心血管风险评估器略有补充价值。
