心电图无症状性心肌梗死作为 ASCVD 风险增强因素在一级预防中的作用：动脉粥样硬化的多种族研究。

The utility of silent myocardial infarction on electrocardiogram as an ASCVD risk enhancer for primary prevention: The multi-ethnic study of atherosclerosis.

机构信息

Section of Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America.

Section of Cardiology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America; Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston-Salem, NC, United States of America.

出版信息

J Electrocardiol. 2021 Mar-Apr;65:105-109. doi: 10.1016/j.jelectrocard.2021.01.018. Epub 2021 Feb 2.

DOI:10.1016/j.jelectrocard.2021.01.018

PMID:33588257

Abstract

BACKGROUND

The 2018 AHA/ACC cholesterol guidelines introduced a new list of markers called "risk enhancers" that, if present, confer an increased risk of atherosclerotic cardiovascular disease (ASCVD). Silent myocardial infarction (SMI) on electrocardiogram (ECG) is notably absent, even though it associated with future ASCVD.

METHODS

We assessed the utility of SMI on ECG as a risk-enhancer in intermediate-risk participants in MESA (Multi-Ethnic Study of Atherosclerosis) - those with 10-year ASCVD risk of 5-20% by the pooled cohort equation (PCE). SMI was defined as major Q-wave abnormality or minor Q/QS waves in the setting of major ST-T abnormalities without prevalent clinical cardiovascular disease.

RESULTS

Among 2946 participants (mean age 63.1 ± 7.6, 53.9% women, 36% white, 11% Chinese-American, 33% African-American, 19% Hispanic), 66 (2.2%) had SMI at baseline. After a median 15.8 years of follow-up, incident ASCVD events occurred in 431/2876 (15.0%) of those without SMI and 16/66 (24.2%) of those with SMI. In a multivariable-adjusted Cox proportional hazards model, baseline SMI was associated with an increased risk of incident ASCVD events (HR 1.68, 95% CI 1.02-2.77, p = 0.04). However, adding SMI to the PCE did not improve discrimination and reclassification was modest-net reclassification improvement was 0.0161 (95% CI 0.002-0.034, p = 0.08).

CONCLUSION

Our findings suggest that the prevalence of SMI is 2.2% among those without known clinical cardiovascular disease considered intermediate-risk by the PCE. In our analysis, SMI only modestly improved classification of risk, suggesting that it may not be very useful as an ASCVD risk enhancer.

摘要

背景

2018 年美国心脏协会/美国心脏病学会胆固醇指南引入了一组新的标志物，称为“风险增强剂”，如果存在这些标志物，会增加动脉粥样硬化性心血管疾病（ASCVD）的风险。心电图（ECG）上的无症状性心肌梗死（SMI）明显缺失，尽管它与未来的 ASCVD 相关。

方法

我们评估了 ECG 上的 SMI 作为 MESA（动脉粥样硬化多民族研究）中中等风险参与者（通过合并队列方程（PCE）预测的 10 年 ASCVD 风险为 5-20%）的风险增强剂的效用。SMI 定义为在没有明显临床心血管疾病的情况下，主要 ST-T 异常伴主要 Q 波异常或小 Q/QS 波。

结果

在 2946 名参与者（平均年龄 63.1±7.6 岁，53.9%为女性，36%为白人，11%为华裔美国人，33%为非裔美国人，19%为西班牙裔美国人）中，基线时有 66 人（2.2%）存在 SMI。在中位随访 15.8 年后，无 SMI 的 2876 人中发生了 431 例（15.0%），有 SMI 的 66 人中发生了 16 例（24.2%）ASCVD 事件。在多变量调整的 Cox 比例风险模型中，基线 SMI 与 ASCVD 事件的发生风险增加相关（HR 1.68，95%CI 1.02-2.77，p=0.04）。然而，将 SMI 添加到 PCE 中并没有改善区分度，再分类效果也较小-净再分类改善为 0.0161（95%CI 0.002-0.034，p=0.08）。