BACKGROUND: We sought to perform a study assessing the association between electrocardiographic ST-segment deviations and cardiovascular death (CVD), in relation to sex and age (≥ and <65 years), in a large primary care population without overt ischemic heart disease. METHODS AND RESULTS: Using computerized analysis of ECGs from 285 194 persons, we evaluated the association between precordial ST-segment deviations and the risk of CVD. All data on medication, comorbidity, and outcomes were retrieved from Danish registries. After a median follow-up period of 5.8 years, there were 6679 cardiovascular deaths. Increasing ST-depression was associated with an increased risk of CVD in almost all of the precordial leads, with the most robust association seen in lead V5 to V6. ST-elevations in lead V2 to V6 were associated with increased risk of CVD in young women, but not in men. However, ST-elevations in V1 increased the risk for both genders and age groups, exemplified by a HR of 1.80 (95% CI [1.19 to 2.74], P=0.005) for men <65 years with ST-elevations ≥ 150 μV versus a nondeviating ST-segment (-50 μV to +50 μV). In contrast, for men <65 years, ST-elevations in lead V2 to V3 conferred a decreased risk of CVD with a HR of 0.77 (95% CI [0.62 to 0.96], P<0.001) for ST-elevations ≥ 150 μV in V2. CONCLUSION: We found that ST-depressions were associated with a dose-responsive increased risk of CVD in nearly all the precordial leads. ST-elevations conferred an increased risk of CVD in women and with regard to lead V1 also in men. However, ST-elevations in V2 to V3 were associated with a decreased risk of CVD in young men.
Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 2014, Vol 3, Issue 3, p. 1-16
Journal Article; Research Support, Non-U.S. Gov't; Adult; Age Factors; Aged; Aged, 80 and over; Cardiovascular Diseases; Denmark; Electrocardiography; Female; Heart; Humans; Male; Middle Aged; Proportional Hazards Models; Risk Factors; Sex Factors