Abstract
Background
Electrocardiogram (ECG) scores have been demonstrated to predict CV mortality but they are rarely utilized clinically.
Objective
Develop a simple score consisting of adding classical ECG abnormalities to make the ECG a more convenient prognostic tool.
Methods
Resting ECGs of 29,320 outpatient male veterans from the Palo Alto Veteran Affairs Healthcare System (PAVHS) collected between 1987 and 2000 were computer analyzed with an average follow‐up of 7.5 y. Twelve classic ECG abnormalities were chosen on the basis of prevalence and corresponding relative risks, including left and right bundle branch block, diagnostic Q waves, intraventricular conduction defect, atrial fibrillation, left atrial abnormality, left and right axis deviation, left and right ventricular hypertrophy, ST depression, and abnormal QTc interval. A simple score derived from the summation of these criteria was then entered into an age and heart rate adjusted Cox analysis.
Results
There was a progressive increase in risk of death as the number of ECG abnormalities increased. The relative risks for 1, 2, 3, 4, and 5 ECG abnormalities were 1.8 (CI 1.6–2.0), 2.4 (CI 2.2–2.7), 3.6 (CI 3.2–4.1), 4.5 (CI 3.8–5.4), and 6.0 (CI 4.7–7.8) respectively (p < 0.001). The age‐adjusted hazard ratio for CV mortality was 6.0 when there were five or more ECG abnormalities present.
Conclusion
Summing the number of classical ECG abnormalities provides a powerful predictor of CV mortality independent of age, standard risk factors, and clinical status. Copyright © 2009 Wiley Periodicals, Inc.
Keywords: electrocardiogram, ECG score, cardiovascular mortality, prognosis
Full Text
The Full Text of this article is available as a PDF (160.6 KB).
References
- 1. Ashley EA, Raxwal VK, Froelicher VF: The prevalence and prognostic significance of electrocardiographic abnormalities. Curr Probl Cardiol 2000; 25: 1–72. [DOI] [PubMed] [Google Scholar]
- 2. Prineas RJ, Crow RS, Blackburn H: The Minnesota Code Manual of Electrocardiographic Findings. Boston, MA: John Wright PSG Inc; 1982; 223–229. [Google Scholar]
- 3. Rautaharju PM, Warren JW, Jain U, Wolf HK, Nielsen CL: Cardiac infarction injury score: an electrocardiographic coding scheme for ischemic heart disease. Circulation 1981; 64: 249–256. [DOI] [PubMed] [Google Scholar]
- 4. Selvester RH, Collier CR, Pearson RB: Analog computer model of the vectocardiogram. Circulation 1979; 60: 805–814. [DOI] [PubMed] [Google Scholar]
- 5. Richardson K, Engel G, Yamazaki T, Chun S, Froelicher VF: Electrocardiographic damage scores and cardiovascular mortality. Am Heart J 2005; 149: 458–463. [DOI] [PubMed] [Google Scholar]
- 6. Hsieh BP, Pham MX, Froelicher VF: Prognostic value of electrocardiographic criteria for left ventricular hypertrophy. Am Heart J 2005; 150(1): 161–167. [DOI] [PubMed] [Google Scholar]
- 7. Horibe H, Kasagi F, Kagaya M, Matsutani Y, Okayama A, et al.: The NIPPON TATA80 Research Group; working group of electrocardiographic coding for the national survey of circulatory disorders, 1980. A nineteen‐year cohort study on the relationship of electrocardiographic findings to all cause mortality among subjects in the national survey on circulatory disorders, NIPPON DATA80. J Epidemiol 2005; 15(4): 125–134. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8. Crow RS, Prineas RJ, Hannan PJ, Garndits G, Blackburn H: Prognostic associations of Minnesota code serial electrocardiographic change classification with coronary heart disease mortality in the Multiple Risk Factor Intervention Trial (MRFIT). Am J Cardiol 1997; 80: 138–144. [DOI] [PubMed] [Google Scholar]
- 9. Wagner GS, Freye CJ, Palmeri ST, Roark SF, Stack NC, et al.: Evaluation of a QRS scoring system for estimating myocardial infarct size. I. Specificity and observer agreement. Circulation 1982; 65: 342–347. [DOI] [PubMed] [Google Scholar]
- 10. Jones MG, Anderson KM, Wilson PW, Kannel WB, Wagner NB, et al.: Prognostic use of aQRS scoring system after hospital discharge for initial acute myocardial infarction in the Framingham cohort. Am J Cardiol 1990; 66: 546–550. [DOI] [PubMed] [Google Scholar]
- 11. Fioretti P, Tijssen JG, Azar AJ, Lazzeroni E, Brower RW, et al.: Prognostic value of predischarge 12 lead electrocardiogram after myocardial infarction compared with other routine clinical variables. Br Heart J 1987; 57: 306–312. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12. Van Domburg RT, Klootwijk P, Deckers JW, van Bergen PFMM, Jonker JJC, et al.: The cardiac infarction injury score as a predictor of long term mortality in survivors of myocardial infarction. Eur Heart J 1998; 19: 1034–1041. [DOI] [PubMed] [Google Scholar]
- 13. Dekker JM, Schouten EG, Kromhout D, Klootwijk P, Pool J: The cardiac infarction injury score and coronary heart disease in middle‐aged and elderly men: the Zutphen study. J Clin Epidemiol 1995; 48: 833–840. [DOI] [PubMed] [Google Scholar]
- 14. Dekker JM, Schouten EG, Pool J, Kok FJ: Cardiac infarction injury score predicts cardiovascular mortality in apparently healthy men and women. Br Heart J 1994; 72: 39–44. [DOI] [PMC free article] [PubMed] [Google Scholar]