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Li Y, Tang C, Wu W, Li Z, Li X, Huang W, Chen W, Mai X, Li X, Xu C, Xie G, Liang J. Abnormal blood lipid and electrocardiogram characteristics in common mental disorders. BMC Psychiatry 2023; 23:465. [PMID: 37365547 DOI: 10.1186/s12888-023-04965-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/16/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND At present, there is not enough evidence to prove the relationship between blood lipid and electrocardiogram (ECG) abnormalities in common mental disorders (CMD). This study aimed to explore the relationship between them, to detect and prevent arrhythmia or sudden death. METHODS We collected 272 CMD patients (maintained a fixed drug dose pattern for 1 year or more), including 95 schizophrenias (SC), 90 bipolar disorders (BD) and 87 major depressive disorders (MDD), and 78 healthy controls (HC) from the Third People's Hospital of Foshan, China. We analyzed and compared their blood lipid and ECG indicators, to clarify the relationship between them. RESULTS 350 participants were included. There were no significant differences in age, gender, total cholesterol (TC), low density lipoprotein (LDL) and QTc (p > 0.05) among subjects. And there were significant differences in body mass index (BMI), triglyceride (TG), high density lipoprotein (HDL), heart rate, PR interval and QRS width (p < 0.05). Person correlation analysis showed that QRS width was positively correlated with BMI and TG. And negatively correlated with HDL. Meanwhile, QTc was positively correlated with BMI. Multiple linear regional analysis further proved that TG (B = 3.849, p = 0.007) and LDL (B = 11.764, p = 0.018) were the risk factors, and HDL (B = -9.935, p = 0.025) was the protective factor for QRS width increase. CONCLUSION Long term medication of CMD patients should strengthen weight management, and conduct regular blood lipid and ECG examinations to achieve early detection and intervention in order to promote their health.
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Affiliation(s)
- Yan Li
- Department of Psychiatry, The Third People's Hospital of Foshan, Guangdong, People's Republic of China
| | - Chaohua Tang
- Department of Psychiatry, The Third People's Hospital of Foshan, Guangdong, People's Republic of China
| | - Weibo Wu
- Department of Psychiatry, The Third People's Hospital of Foshan, Guangdong, People's Republic of China
| | - Zhijian Li
- Department of Psychiatry, The Third People's Hospital of Foshan, Guangdong, People's Republic of China
| | - Xuesong Li
- Department of Psychiatry, The Third People's Hospital of Foshan, Guangdong, People's Republic of China
| | - Wei Huang
- Department of Psychiatry, The Third People's Hospital of Foshan, Guangdong, People's Republic of China
| | - Wensheng Chen
- Department of Psychiatry, The Third People's Hospital of Foshan, Guangdong, People's Republic of China
| | - Xiancong Mai
- Department of Psychiatry, The Third People's Hospital of Foshan, Guangdong, People's Republic of China
| | - Xiaoling Li
- Department of Psychiatry, The Third People's Hospital of Foshan, Guangdong, People's Republic of China
| | - Caixia Xu
- Department of Psychiatry, The Third People's Hospital of Foshan, Guangdong, People's Republic of China
| | - Guojun Xie
- Department of Psychiatry, The Third People's Hospital of Foshan, Guangdong, People's Republic of China.
| | - Jiaquan Liang
- Department of Psychiatry, The Third People's Hospital of Foshan, Guangdong, People's Republic of China.
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2
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Tam To B, Roy R, Melikian N, Gaughran FP, O’Gallagher K. Coronary Artery Disease in Patients with Severe Mental Illness. Interv Cardiol 2023; 18:e16. [PMID: 37398869 PMCID: PMC10311395 DOI: 10.15420/icr.2022.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/23/2022] [Indexed: 07/04/2023] Open
Abstract
Severe mental illnesses (SMI), such as schizophrenia and bipolar disorder, are associated with a decrease in life expectancy of up to two decades compared with the general population, with cardiovascular disease as the leading cause of death. SMI is associated with increased cardiovascular risk profile and early onset of incident cardiovascular disease. Following an acute coronary syndrome, patients with SMI have a worse prognosis, but are less likely to receive invasive treatment. In this narrative review, the management of coronary artery disease in patients with SMI is discussed, and avenues for future research are highlighted.
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Affiliation(s)
- Brian Tam To
- Cardiovascular Department, King’s College Hospital NHS Foundation TrustLondon, UK
| | - Roman Roy
- Cardiovascular Department, King’s College Hospital NHS Foundation TrustLondon, UK
| | - Narbeh Melikian
- Cardiovascular Department, King’s College Hospital NHS Foundation TrustLondon, UK
- School of Cardiovascular and Metabolic Medicine & Sciences, British Heart Foundation Centre of Research Excellence, King’s College LondonLondon, UK
| | - Fiona P Gaughran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College LondonLondon, UK
- National Psychosis Service, South London and Maudsley NHS Foundation TrustLondon, UK
| | - Kevin O’Gallagher
- Cardiovascular Department, King’s College Hospital NHS Foundation TrustLondon, UK
- School of Cardiovascular and Metabolic Medicine & Sciences, British Heart Foundation Centre of Research Excellence, King’s College LondonLondon, UK
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3
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Blok-Husum L, Brcelic MAR, Bassi HKFK, Jensen SE, Nielsen RE, Kragholm K, Fleischer J, Laugesen E, Polcwiartek C. Cardiovascular autonomic reflex tests using a handheld device in the diagnosis of cardiovascular autonomic neuropathy in patients with schizophrenia. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 26:100252. [PMID: 38510185 PMCID: PMC10945952 DOI: 10.1016/j.ahjo.2023.100252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 03/22/2024]
Abstract
Study objective This study investigated whether schizophrenia and the duration of schizophrenia were associated with cardiovascular autonomic neuropathy (CAN) by using heart rate variability (HRV) as a marker. Design Cross-sectional study. Setting The examinations were conducted at the Centre for Psychosis Research and at the Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark. Participants 240 patients with first-episode and chronic schizophrenia and 180 controls. Interventions CAN was assessed by the cardiovascular reflex tests (CARTs): HR, RS ratio, E:I ratio, and VM using a handheld device. Main outcome measures One abnormal CART was interpreted as borderline CAN and ≥2 abnormal CARTs established definitive CAN. Borderline CAN and definitive CAN together was categorized as overall CAN. Analyses were adjusted for age, sex, smoking, overweight, and hypercholesterolemia. Results A total of 240 patients with schizophrenia (median age 42.5 [28.8, 52.3], 42.9 % women) and 180 controls (median age 45.8 [24.0, 60.1], 47.8 % women) were included, with 50.8 % of patients with schizophrenia having overall CAN compared to 27.2 % among controls. Dividing patients into patients with first-episode and chronic schizophrenia, 32.9 % vs 10 % (p < 0.001) and 59.1 % vs 41 % (p < 0.001) had overall CAN compared with controls, respectively. Schizophrenia was significantly associated with overall CAN (OR, 2.80; 95%CI, 1.75-4.50), with an OR of 2.31 (95%CI, 1.14-4.68) for first-episode schizophrenia and an OR of 2.97 (95%CI, 1.81-4.87) for chronic schizophrenia. Conclusion It was demonstrated that a diagnosis of schizophrenia was associated with CAN. Patients with chronic schizophrenia had a significantly higher prevalence of CAN compared to patients with first-episode schizophrenia, suggesting an association between the duration of schizophrenia and CAN.
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Affiliation(s)
- Laura Blok-Husum
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | | | | | - Svend Eggert Jensen
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Rene Ernst Nielsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Aalborg University Hospital, Psychiatry, Aalborg, Denmark
| | - Kristian Kragholm
- Aalborg University Hospital, Department of Cardiology, Aalborg, Denmark
| | - Jesper Fleischer
- Steno Diabetes Center Aarhus, Aarhus, Denmark
- Steno Diabetes Center Zealand, Zealand, Denmark
| | - Esben Laugesen
- Regional Hospital Horsens, Department of Medicine, Horsens, Denmark
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4
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Polcwiartek C, Atwater BD, Kragholm K, Friedman DJ, Barcella CA, Attar R, Graff C, Nielsen JB, Pietersen A, Søgaard P, Torp-Pedersen C, Jensen SE. Association Between ECG Abnormalities and Fatal Cardiovascular Disease Among Patients With and Without Severe Mental Illness. J Am Heart Assoc 2021; 10:e019416. [PMID: 33432845 PMCID: PMC7955293 DOI: 10.1161/jaha.120.019416] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background ECG abnormalities are associated with adverse outcomes in the general population, but their prognostic significance in severe mental illness (SMI) remains unexplored. We investigated associations between no, minor, and major ECG abnormalities and fatal cardiovascular disease (CVD) among patients with SMI compared with controls without mental illness. Methods and Results We cross‐linked data from Danish nationwide registries and included primary care patients with digital ECGs from 2001 to 2015. Patients had SMI if they were diagnosed with schizophrenia, bipolar disorder, or severe depression before ECG recording. Controls were required to be without any prior mental illness or psychotropic medication use. Fatal CVD was assessed using hazard ratios (HRs) with 95% CIs and standardized 10‐year absolute risks. Of 346 552 patients, 10 028 had SMI (3%; median age, 54 years; male, 45%), and 336 524 were controls (97%; median age, 56 years; male, 48%). We observed an interaction between SMI and ECG abnormalities on fatal CVD (P<0.001). Severe mental illness was associated with fatal CVD across no (HR, 2.17; 95% CI, 1.95–2.43), minor (HR, 1.90; 95% CI, 1.49–2.42), and major (HR, 1.40; 95% CI, 1.26–1.55) ECG abnormalities compared with controls. Across age‐ and sex‐specific subgroups, SMI patients with ECG abnormalities but no CVD at baseline had highest standardized 10‐year absolute risks of fatal CVD. Conclusions ECG abnormalities conferred a poorer prognosis among patients with SMI compared with controls without mental illness. SMI patients with ECG abnormalities but no CVD represent a high‐risk population that may benefit from greater surveillance and risk management.
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Affiliation(s)
- Christoffer Polcwiartek
- Department of Cardiology Aalborg University Hospital Aalborg Denmark.,Division of Cardiology Duke University Medical Center Durham NC.,Department of Clinical Medicine Aalborg University Aalborg Denmark
| | - Brett D Atwater
- Division of Cardiology Duke University Medical Center Durham NC
| | - Kristian Kragholm
- Department of Cardiology Aalborg University Hospital Aalborg Denmark
| | - Daniel J Friedman
- Section of Cardiac Electrophysiology Yale School of Medicine New Haven CT
| | - Carlo A Barcella
- Department of Cardiology Copenhagen University Hospital Gentofte Hellerup Denmark
| | - Rubina Attar
- Department of Cardiology Aalborg University Hospital Aalborg Denmark.,Department of Clinical Sciences Lund University Lund Sweden
| | - Claus Graff
- Department of Health Science and Technology Aalborg University Aalborg Denmark
| | - Jonas B Nielsen
- Laboratory for Molecular Cardiology The Heart CenterCopenhagen University HospitalRigshospitalet Copenhagen Denmark
| | | | - Peter Søgaard
- Department of Cardiology Aalborg University Hospital Aalborg Denmark.,Department of Clinical Medicine Aalborg University Aalborg Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology Aalborg University Hospital Aalborg Denmark.,Department of Cardiology and Clinical Research Nordsjælland Hospital Hillerød Denmark
| | - Svend E Jensen
- Department of Cardiology Aalborg University Hospital Aalborg Denmark.,Department of Clinical Medicine Aalborg University Aalborg Denmark
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5
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Cao H, Zhou Y, Li T, Yao C, Yang W, Kong S, Wang Y, Yu B, Jiao Q, Sun Y, Jia X, Wang Y, Wang Z, Zhang X, Li J. The Prevalence, Risk Factors and Clinical Correlates of QTc Prolongation in Chinese Hospitalized Patients With Chronic Schizophrenia. Front Psychiatry 2021; 12:704045. [PMID: 34483996 PMCID: PMC8416174 DOI: 10.3389/fpsyt.2021.704045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/22/2021] [Indexed: 12/02/2022] Open
Abstract
Background: The QTc interval may be significantly prolonged in schizophrenia patients taking antipsychotics. Few studies have addressed QTc prolongation (QTP) in Chinese patients. Objectives: This study was designed to evaluate the prevalence of QTP and its clinical correlates in Chinese hospitalized patients with chronic schizophrenia. Methods: A total of 436 inpatients and 291 normal controls matched with age and sex were included. QTc prolongation was defined as 2 standard deviations (SD) above the mean value of normal controls. Positive and Negative Syndrome Scale (PANSS) and its five-factor model were used to evaluate psychopathological symptoms. Results: QTc interval was significantly longer in patients than in normal controls. The prevalence of QTP is 8.26% in Chinese hospitalized patients with chronic schizophrenia. More women than men displayed QTP. Compared with patients without QTP, the patients with QTP had significantly higher concrete/disorganized subscore, lower low density lipoprotein (LDL) and lower total protein (TP). Furthermore, binary logistic regression analysis showed that higher number of hospitalizations, higher concrete/disorganized subscore and lower LDL were risk factors for QTP. Correlation analysis indicated significant association between QTc interval and the following variables: sex, age, duration of illness, the number of hospitalizations, PANSS total score, fasting blood glucose (FPG). Finally, a multiple regression analysis showed that older age, antipsychotic polypharmacy, higher PANSS total score, and lower LDL were risk factors for QTP. Among them, LDL seemed to be a protective factor for QTP. Conclusions: QTc interval was longer in schizophrenia patients than in normal controls. The prevalence of QTP is 8.26% in Chinese hospitalized patients with chronic schizophrenia. Some clinical characteristics were risk factors for QTP. And LDL seemed to be a protective factor for QTP.
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Affiliation(s)
- Haiyan Cao
- Institute of Mental Health, Tianjin Anding Hospital, Tianjin Medical University, Tianjin, China
| | - Yongjie Zhou
- Department of Psychiatric Rehabilitation, Shenzhen Kangning Hospital, Shenzhen, China
| | - Tao Li
- Institute of Mental Health, Tianjin Anding Hospital, Tianjin Medical University, Tianjin, China
| | - Cong Yao
- Institute of Mental Health, Tianjin Anding Hospital, Tianjin Medical University, Tianjin, China
| | - Weiliang Yang
- Institute of Mental Health, Tianjin Anding Hospital, Tianjin Medical University, Tianjin, China
| | - Siying Kong
- Institute of Mental Health, Tianjin Anding Hospital, Tianjin Medical University, Tianjin, China
| | - Yanyan Wang
- Institute of Mental Health, Tianjin Anding Hospital, Tianjin Medical University, Tianjin, China
| | - Baoping Yu
- Institute of Mental Health, Tianjin Anding Hospital, Tianjin Medical University, Tianjin, China
| | - Qingyan Jiao
- Institute of Mental Health, Tianjin Anding Hospital, Tianjin Medical University, Tianjin, China
| | - Yun Sun
- Institute of Mental Health, Tianjin Anding Hospital, Tianjin Medical University, Tianjin, China
| | - Xiaoju Jia
- Institute of Mental Health, Tianjin Anding Hospital, Tianjin Medical University, Tianjin, China
| | - Yuting Wang
- Institute of Mental Health, Tianjin Anding Hospital, Tianjin Medical University, Tianjin, China
| | - Zhonggang Wang
- Department of Psychiatry, Jining Psychiatric Hospital, Jining, China
| | - Xiangyang Zhang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Jie Li
- Institute of Mental Health, Tianjin Anding Hospital, Tianjin Medical University, Tianjin, China
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6
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Attar R, Wester A, Koul S, Eggert S, Polcwiartek C, Jernberg T, Erlinge D, Andell P. Higher risk of major adverse cardiac events after acute myocardial infarction in patients with schizophrenia. Open Heart 2020; 7:openhrt-2020-001286. [PMID: 32994353 PMCID: PMC7526274 DOI: 10.1136/openhrt-2020-001286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/29/2020] [Accepted: 08/03/2020] [Indexed: 11/22/2022] Open
Abstract
Background Patients with schizophrenia are a high-risk population due to higher prevalences of cardiovascular risk factors and comorbidities that contribute to shorter life expectancy. Purpose To investigate patients with and without schizophrenia experiencing an acute myocardial infarction (AMI) in relation to guideline recommended in-hospital management, discharge medications and 5-year major adverse cardiac events (MACE: composite of all-cause mortality, rehospitalisation for reinfarction, stroke or heart failure). Methods All patients with schizophrenia who experienced AMI during 2000–2018 were identified (n=1008) from the nationwide Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry and compared with AMI patients without schizophrenia (n=2 85 325). Kaplan-Meier survival curves and multivariable Cox regression models were used to compare the populations. Results Patients with schizophrenia presented with AMI approximately 10 years earlier (median age 64 vs 73 years), and had higher prevalences of diabetes, heart failure and chronic obstructive pulmonary disease. They were less likely to be invasively investigated or discharged with aspirin, P2Y12 inhibitors, ACE inhibitors/angiotensin II receptor blockers, beta-blockers and statins (all p<0.005). AMI patients with schizophrenia had higher adjusted risk of MACE (aHR=2.05, 95% CI 1.63 to 2.58), mortality (aHR=2.38, 95% CI 1.84 to 3.09) and hospitalisation for heart failure (aHR=1.39, 95% CI 1.04 to 1.86) compared with AMI patients without schizophrenia. Conclusion Patients with schizophrenia experienced an AMI almost 10 years earlier than patients without schizophrenia. They less often underwent invasive procedures and were less likely to be treated with guideline recommended medications at discharge, and had more than doubled risk of MACE and all-cause mortality. Improved primary and secondary preventive measures, including adherence to guideline recommendations, are warranted and may improve outcome.
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Affiliation(s)
- Rubina Attar
- Cardiology and Clinical Sciences, Lund University, Lund, Sweden .,Cardiology and Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Axel Wester
- Cardiology and Clinical Sciences, Lund University, Lund, Sweden
| | - Sasha Koul
- Cardiology, Lund University, Lund, Sweden
| | - Svend Eggert
- Cardiology and Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | | | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - David Erlinge
- Cardiology and Clinical Sciences, Lund University, Lund, Sweden
| | - Pontus Andell
- Cardiology and Clinical Sciences, Lund University, Lund, Sweden.,Unit of Cardiology, Department of medicine and Heart and Vascular Division, Karolinska Institute, Stockholm, Sweden
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Long-Term Prognostic Value of Less-Stringent Electrocardiographic Q Waves and Fourth Universal Definition of Myocardial Infarction Q Waves. Am J Med 2020; 133:582-589.e7. [PMID: 31647913 DOI: 10.1016/j.amjmed.2019.08.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/29/2019] [Accepted: 08/30/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND The Fourth Universal Definition of Myocardial Infarction defines electrocardiographic Q waves as duration ≥30 ms and amplitude ≥1 mm or QS complex in 2 contiguous leads. However, current taskforce criteria may be overly restrictive. Therefore, we investigated the association of isolated, lenient, or strict Q waves with long-term outcome. METHODS From 2001 to 2015, we included Danish primary care patients with digital electrocardiograms (ECGs) that were evaluated for Q waves. If none occurred, patients had no Q waves. If no other contiguous Q wave occurred, patients had isolated Q waves. If another contiguous Q wave occurred meeting only 1 criterion (≥30 ms and <1 mm or <30 ms and ≥1 mm), patients had lenient Q waves. If another contiguous Q wave occurred, patients had strict Q waves. RESULTS Of 365,206 patients, 87,957 had isolated, lenient, or strict Q waves (24%; median age, 61 years; male, 48%), and 277,249 had no Q waves (76%; median age, 53 years; male, 42%). Mortality risk was increased with isolated (all-cause adjusted hazard ratio [aHR], 1.33; 95% confidence interval [CI], 1.29-1.37; cardiovascular-cause aHR, 1.78; 95% CI, 1.70-1.87), lenient (all-cause aHR, 1.41; 95% CI, 1.33-1.50; cardiovascular-cause aHR, 1.78; 95% CI, 1.63-1.94), or strict (all-cause aHR, 1.64; 95% CI, 1.57-1.72; cardiovascular-cause aHR, 2.70; 95% CI, 2.52-2.89) Q waves compared with no Q waves. Highest mortality risk was associated with lenient or strict Q waves in anteroseptal leads. CONCLUSIONS This large contemporary analysis suggests that less-stringent Q-wave criteria carry prognostic value in predicting adverse outcome among primary care patients.
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