The purpose of the study is to examine the prevalence and significance of minor nonspecific ST-segment and T-wave abnormalities (NSSTTA) in the prediction of future cardiovascular disease (CVD) events. Minor NSSTTA are commonly encountered in clinical practice. To date, there have been no systematic reviews focusing on the prevalence and prognostic importance of these findings. Literature searches of MEDLINE (1966-2005) were supplemented with searches of bibliographies from key articles. We focused on isolated minor NSSTTA in healthy middle-aged or elderly populations, including men, women, blacks, and whites, and the association of isolated minor NSSTTA with incident cardiovascular and coronary events. Isolated minor NSSTTA are common in middle-aged white men (ranging from 3.6% to 10.3%), and seem to be even more prevalent in women, blacks, and the elderly. In the 3 studies that examined isolated minor NSSTTA, the multivariable-adjusted hazard ratios for coronary mortality ranged from 1.24 to 1.66. Although gender, race, and age-specific differences in the prognostic significance of minor NSSTTA are not clear because of limited data, minor NSSTTA in asymptomatic patients are an important risk factor for coronary and cardiovascular mortality, independent of traditional risk factors. Minor NSSTTA are prevalent in asymptomatic individuals, and they confer increased risk for CVD and coronary heart disease (CHD), independent of traditional risk factors. Future studies with standardized methodology are needed to elucidate the physiological significance of minor NSSTTA and to further describe gender, race, and age-related differences in the prevalence and prognostic significance of minor NSSTTA.

Background-The prevalence and prognostic significance of isolated minor nonspecific ST-segment and T-wave abnormalities (NSSTTAs) in older adults are poorly understood. Methods and Results-Cardiovascular Health Study participants free of both clinical cardiovascular disease and major ECG abnormalities were included. We examined the prospective association of isolated minor NSSTTAs (defined by Minnesota Codes 4 -3, 4 -4, 5-3, and 5-4) with total, cardiovascular, and coronary mortality and incident nonfatal myocardial infarction. Among 3224 participants (61.9% women; mean age, 72 years), 233 (7.2%) had isolated NSSTTAs at baseline. Covariates associated with isolated NSSTTAs included older age, nonwhite race (20.5% of blacks versus 4.8% of whites; PϽ0.001), diabetes, and higher blood pressure and body mass index but not the presence of subclinical cardiovascular disease. After 39 518 person-years of follow-up, the presence of isolated NSSTTAs was associated with significantly increased risk for coronary heart disease mortality (multivariable-adjusted hazards ratio, 1.76; 95% CI, 1.18 to 2.61) but not with incident nonfatal myocardial infarction (multivariable-adjusted hazards ratio, 0.71; 95% CI, 0.43 to 1.17). The association of isolated NSSTTAs with coronary death was independent of subclinical atherosclerosis and left ventricular mass measures. In secondary analyses, among those with cardiac death, there was a significantly higher rate of primary arrhythmic death (32.3% versus 15.4%; Pϭ0.02) in participants with isolated NSSTTAs versus those without NSSTTAs. Conclusions-Isolated NSSTTAs are common in older Americans and are associated with significantly increased risk for coronary death. However, isolated NSSTTAs are not associated with incident nonfatal myocardial infarction, suggesting that they are associated particularly with increased risk for primary arrhythmic death.