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Common electrocardiographic markers for subsequent clinical coronary events

MAJOR MANIFESTATIONS of ischemic myocardial involvement often occur in the absence of symptoms. Silent myocardial infarction is an unequivocal electrocardiographic manifestation of inapparent ischemic disease. Disturbance of intraventricular conduction and repolarization on electrocardiographic examination also often reflect ischemic myocardial damage. The risk associated with these electrocardiographic abberations was ascertained over 30 years of surveillance of 5127 participants in the Framingham Study. Nonspecific repolarization abnormalities, intraventricular conduction disturbance, and left ventricular hypertrophy in persons without symptoms were each associated with an increased risk of all clinical manifestations of coronary disease (table 1). Risk of developing clinical manifestations of coronary disease was twofold greater in those who exhibited nonspecific ECG abnormality than in those who remained free of it (table 1). All clinical manifestations of coronary disease, including myocardial infarction, angina, and sudden death, occurred in excess at all ages in both sexes. This persisted on taking into account associated known coronary risk factors, including hypertension its chief determinant. The more common T wave abnormality carried a significant risk, although combined S-T/T was most hazardous. Intraventricular conduction disturbances and left ventricular hypertrophy carry the same risks of lethal coronary events as overt coronary heart disease. For intraventricular conduction disturbance, the impact was less pronounced and not statistically significant beyond age 65 (table 1). The 10 year age-adjusted incidence of clinically overt coronary disease increased twofold to threefold over that of the general population for both electrocardiographically documented left ventricular hypertrophy (ECG-LVH) and silent myocardial infarction (ECG-MI) (table 2). Mortality from coronary disease, and from sudden death in particular, with also in-