101. Abstract 14080: Electrocardiographic Criteria for Silent Myocardial Infarction: Impact of Different Definitions on Detection Rates and Prognostic Significance in the Atherosclerosis Risk in Communities Study
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Stacey, Richard B, Prineas, Ronald J, Zhang, Zhu-ming, Psaty, Bruce, Rosamond, Wayne D, Wagenknecht, Lynne, and Soliman, Elsayed Z
- Abstract
Introduction:It is unclear how differences in the electrocardiographic (ECG) definition of myocardial infarction (MI) impact detection rates and prognostic significance of silent MI (SMI).Methods:This analysis included 9,188 participants (57.4% women, 20% black, age 62.6 ? 6.0 years) enrolled in the Atherosclerosis Risk in Communities study who had serial ECGs obtained between exam 1 (1987-1989) and exam 4 (1996-1998). Exclusions included known cardiovascular disease prior to exam 1, ECG findings of MI or bundle branch block (BBB) at exam 1, or an adjudicated coronary event between exam 1 and 4. Using the Minnesota Code (MC) ECG Classification and in the absence of adjudicated MI, the following SMI definitions were derived (Table): Standard MC MI [Major Q-wave abnormality, or minor Q-wave abnormality plus major ST/T abnormality, only Major Q-wave abnormality, Standard significant serial Q-wave changes, Expanded MC serial Q-wave changes, Standard MC significant serial Q-wave changes or Standard MC significant serial ST/T changes, and evolving MC BBB . Cox proportional hazard models were used to examine the association of different definitions of MI (compared to no new MI or evolving BBB), with fatal or non-fatal coronary events ascertained after exam-4 until December 2016.Results:The incidence of SMI between exam 1 and exam 4 ranged from 0.6% to 7.0% depending on the ECG criteria applied to define SMI. Presence of incident SMI was predictive of future coronary events after exam 4 regardless of the ECG definition but with varying levels of significance. Standard MC expanded serial Q-wave changes had the strongest relationship while evolving BBB had the weakest association (Table).Conclusions:The incidence and prognostic significance of SMI are impacted by the ECG criteria defining MI. A uniform approach(s) for detection of SMI in population studies which builds on the available standard definitions that fits different research scenarios is needed.
- Published
- 2019
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