PROGNOSTIC VALUE OF ISCHEMIC ELECTROCARDIOGRAPHIC FINDINGS FOR CARDIOVASCULAR MORTALITY IN MEN AND WOMEN

Objectives. The aim of this study was to investigate the independent p rognostic value of ischemic electrocardiographic (ECG) findings for ca rdiovascular mortality and to evaluate a possible sex-differential in this regard. Background. In previous reports, ST segment and T wave ch anges on the resting ECG were described as independent risk factors fo r development of coronary heart disease. Although more prevalent in wo men, they are often given less clinical importance than in men. Method s. Ten-year follow-up data from the Belgian Interuniversity Research o n Nutrition and Health study were used. The results presented here are based on ECGs of the 4,797 men and 4,320 women, aged 25 to 74 years, who were free of angina pectoris at the start of follow-up, had no his tory of myocardial infarction (MI) and showed no Q wave evidence of an old MI on their EGG. Results. At baseline, the age-standardized preva lence of an ''ischemic ECG'' (Minnesota codes I-3, IV1-3, V1-3 or VII1 ) was 8.4% in men and 10.6% in women. Cardiovascular mortality rates i n men and women with an ischemic ECG were respectively 7.7 and 2.6 per 1,000 person-years, compared with 2.3 and 1.0 in those with no such E CG findings. After correction for the potential confounding effects of established cardiovascular disease (CVD) risk factors, the multivaria tely adjusted risk ratios were 2.45 (95% confidence interval [CI]: 1.7 0 to 3.53) for men and 2.16 (95% CI: 1.30 to 3.58) for women. Testing the interaction between an ischemic ECG and ses on CVD mortality revea led that the risk ratios were not significantly changed (p = 0.95). Th e etiologic fraction of CVD deaths attributable to an ischemic ECG was estimated as 19.3% for men and 22.4% for women. Both men and women wi th major ischemic findings in their baseline electrocardiogram (Minnes ota codes IV1,2, V-1,V-2 or VII1) had a fourfold increased risk of CVD death. Conclusion. These results support the hypothesis that women wi th ischemic ECG findings are at the same increased risk for CVD mortal ity as men. (J Am Coil Cardiol 1998;32:680-5) (C) 1998 by the American College of Cardiology.