Objective Cardiovascular diseases (CVDs) are highly preventable non-communicable diseases. ECG is a potential tool for risk stratification with respect to CVD. Our aim was to evaluate ECG’s role in all-cause and cardiovascular mortality prediction. Methods Participants from the Brazilian Longitudinal Study of Adult Health, free of known CVD at baseline were included. A 12-lead ECG was obtained at baseline (2008–2010). Participants were followed up to 2018 by annual interviews. Deaths were independently reviewed. Cox as well as Fine and Grey multivariable regression models were applied to evaluate if the presence of any major electrocardiographic abnormality (MEA), defined according to the Minnesota Code system, would predict total and cardiovascular deaths. We also evaluated the Net Reclassification Index of adding MEA to the Systematic Coronary Risk Evaluation (SCORE). Results The 13 428 participants (median age 51 years, 45% men) were followed up for 8±1 years. All-cause and cardiovascular mortality occurred in 2.8% and 1.2% of the population, respectively. Prevalent MEA was an independent predictor of overall (HR=2.3, 95% CI 1.7 to 2.9) and cardiovascular mortality (HR=4.6, 95% CI 3.0 to 7.0) after adjustments for age, race, education and traditional cardiovascular risk factors. Adding MEA to the SCORE resulted in 9% mis-reclassification in the non-event subgroup and 33% correct reclassification in those with a fatal cardiovascular event. Conclusion Presence of MEA was an independent predictor of overall and cardiovascular mortality. ECG may have a role in risk prediction of cardiovascular mortality in primary care. All data relevant to the study are included in the article or uploaded as supplementary information. All relevant data were included. All data are available.

中文翻译：

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巴西成人健康纵向研究对成人心电图异常的预后价值

目的心血管疾病（CVDs）是高度可预防的非传染性疾病。ECG 是一种潜在的 CVD 风险分层工具。我们的目的是评估心电图在全因死亡率和心血管死亡率预测中的作用。方法 包括来自巴西成人健康纵向研究的参与者，他们在基线时没有已知的 CVD。在基线（2008-2010 年）获得了 12 导联心电图。参与者进行了年度访谈，直至 2018 年。死亡进行了独立审查。应用 Cox 以及 Fine 和 Gray 多变量回归模型来评估根据明尼苏达代码系统定义的任何主要心电图异常 (MEA) 的存在是否会预测总死亡和心血管死亡。我们还评估了将 MEA 添加到系统性冠状动脉风险评估 (SCORE) 的净重分类指数。结果 13 428 名参与者（中位年龄 51 岁，男性占 45%）获得了 8±1 年的随访。全因死亡率和心血管死亡率分别为 2.8% 和 1.2%。在调整年龄、种族、教育和传统心血管危险因素后，普遍存在的 MEA 是总体（HR=2.3，95% CI 1.7 至 2.9）和心血管死亡率（HR=4.6，95% CI 3.0 至 7.0）的独立预测因子。将 MEA 添加到 SCORE 导致非事件亚组中 9% 的错误重新分类和致命心血管事件亚组中 33% 的正确重新分类。结论 MEA 的存在是总体死亡率和心血管死亡率的独立预测因素。心电图可能在初级保健中心血管死亡率的风险预测中起作用。与研究相关的所有数据都包含在文章中或作为补充信息上传。包括所有相关数据。所有数据都可用。