Long-Term Mortality Risk in Individuals With Atrial or Ventricular Premature Complexes (Results from the Third National Health and Nutrition Examination Survey)

• Type of Material: Article
• Authors: Waqas Qureshi, Wake Forest School of Medicine; Amit J. Shah, Emory University; Taufiq Salahuddin, Wake Forest School of Medicine; Elsayed Z. Soliman, Wake Forest School of Medicine
• Language: English
• Date: 2014-07-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2014 Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.amjcard.2014.04.005
• Title of Journal or Parent Work: American Journal of Cardiology
• ISSN: 0002-9149
• Volume: 114
• Issue: 1
• Start Page: 59
• End Page: 64
• Grant/Funding Information: AJ Shah was funded by the NIH grant UL1TR000454 (National Center for Advancing Translational Sciences of the National Institutes of Health) and KL2TR000455 (KL2 scholarship).; W Qureshi is funded by Ruth L. Kirsch stein NRSA Institutional Training Grant 5T32HL076132-10.
• Keywords: MYOCARDIAL-INFARCTION; ARRHYTHMIAS; FREQUENT; POPULATION; ATHEROSCLEROSIS RISK; Cardiovascular System & Cardiology; CORONARY-HEART-DISEASE; CONTRACTIONS; ECTOPY; Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; FIBRILLATION; RHYTHM
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Premature ectopic beats are frequently detected on routine 12-lead screening electrocardiograms (ECGs). However, their prognostic importance in subjects without known cardiovascular disease (CVD) is not well established. We evaluated prognostic value of atrial premature complexes (APCs) and ventricular premature complexes (VPCs) detected by a single 12-lead electrocardiography. A prospective cohort of 7,504 participants selected from nationally representative community-dwelling subjects living in the United States, enrolled in the Third National Health and Nutrition Examination Survey III from 1988 to 1994 with follow-up through December 2006 without known CVD. The main outcomes were all-cause mortality, CVD-related mortality, and ischemic heart disease (IHD)-related mortality. Of 7,504 participants (mean age 60 ± 14 years, 47% women, 49% whites), 89 (1.2%) had APCs and 110 (1.5%) had VPCs on 12-lead ECGs. During a follow-up of up to 18 years, 2,386 deaths occurred, of which 963 were due to CVD and 511 were due to IHD. In a multivariate analysis adjusted for demographics, clinical variables, and electrocardiographic measures, APCs were significantly associated with all-cause mortality (hazard ratio [HR] 1.41, 95% confidence interval [CI] 1.08 to 1.80), CVD death (HR 1.78, 95% CI 1.26 to 2.44), and IHD death (HR 2.40, 95% CI 1.59 to 3.47). For VPCs, however, there were no significant associations with all-cause mortality (HR 1.05, 95% CI 0.80 to 1.36), CVD death (HR 0.96, 95% CI 0.62 to 1.43), and IHD death (HR 0.89, 95% CI 0.47 to 1.52). In conclusion, APCs, but not VPCs, on routine screening ECGs are predictive of adverse events in community-dwelling subjects without known CVD.