Prevalence of ECGs Exceeding Thresholds for ST‐Segment–Elevation Myocardial Infarction in Apparently Healthy Individuals: The Role of Ethnicity

Background Early prehospital recognition of critical conditions such as ST-segment-elevation myocardial infarction (STEMI) has prognostic relevance. Current international electrocardiographic STEMI thresholds are predominantly based on individuals of Western European descent. However, because of eth...

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Published in:	Journal of the American Heart Association Vol. 9; no. 13; p. e015477
Main Authors:	ter Haar, C. Cato, Kors, Jan A., Peters, Ron J. G., Tanck, Michael W. T., Snijder, Marieke B., Maan, Arie C., Swenne, Cees A., van den Born, Bert‐Jan H., de Jong, Jonas S. S. G., Macfarlane, Peter W., Postema, Pieter G.
Format:	Journal Article
Language:	English
Published:	England John Wiley and Sons Inc 07.07.2020 Wiley
Subjects:	Action Potentials Adolescent Adult Aged ECG Electrocardiography ethnicity Female Health Status Disparities Heart Disease Risk Factors Heart Rate HELIUS study Humans Male Middle Aged Missed Diagnosis Netherlands - epidemiology Original Research population study Predictive Value of Tests Prevalence Race Factors Reproducibility of Results Risk Assessment ST Elevation Myocardial Infarction - diagnosis ST Elevation Myocardial Infarction - ethnology ST Elevation Myocardial Infarction - physiopathology STEMI Young Adult Netherlands population study ECG STEMI HELIUS study ethnicity
ISSN:	2047-9980, 2047-9980
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Abstract	Background Early prehospital recognition of critical conditions such as ST-segment-elevation myocardial infarction (STEMI) has prognostic relevance. Current international electrocardiographic STEMI thresholds are predominantly based on individuals of Western European descent. However, because of ethnic electrocardiographic variability both in health and disease, there is a need to reevaluate diagnostic ST-segment elevation thresholds for different populations. We hypothesized that fulfillment of ST-segment elevation thresholds of STEMI criteria (STE-ECGs) in apparently healthy individuals is ethnicity dependent. Methods and Results HELIUS (Healthy Life in an Urban Setting) is a multiethnic cohort study including 10 783 apparently healthy subjects of 6 different ethnicities (African Surinamese, Dutch, Ghanaian, Moroccan, South Asian Surinamese, and Turkish). Prevalence of STE-ECGs across ethnicities, sexes, and age groups was assessed with respect to the 2 international STEMI thresholds: sex and age specific versus sex specific. Mean prevalence of STE-ECGs was 2.8% to 3.4% (age/sex-specific and sex-specific thresholds, respectively), although with large ethnicity-dependent variability. Prevalences in Western European Dutch were 2.3% to 3.0%, but excessively higher in young (<40 years) Ghanaian males (21.7%-27.5%) and lowest in older (≥40 years) Turkish females (0.0%). Ethnicity (sub-Saharan African origin) and other variables (eg, younger age, male sex, high QRS voltages, or anterolateral early repolarization pattern) were positively associated with STE-ECG occurrence, resulting in subgroups with >45% STE-ECGs. Conclusions The accuracy of diagnostic tests partly relies on background prevalence in healthy individuals. In apparently healthy subjects, there is a highly variable ethnicity-dependent prevalence of ECGs with ST-segment elevations exceeding STEMI thresholds. This has potential consequences for STEMI evaluations in individuals who are not of Western European descent, putatively resulting in adverse outcomes with both over- and underdiagnosis of STEMI.
AbstractList	Background Early prehospital recognition of critical conditions such as ST‐segment–elevation myocardial infarction (STEMI) has prognostic relevance. Current international electrocardiographic STEMI thresholds are predominantly based on individuals of Western European descent. However, because of ethnic electrocardiographic variability both in health and disease, there is a need to reevaluate diagnostic ST‐segment elevation thresholds for different populations. We hypothesized that fulfillment of ST‐segment elevation thresholds of STEMI criteria (STE‐ECGs) in apparently healthy individuals is ethnicity dependent. Methods and Results HELIUS (Healthy Life in an Urban Setting) is a multiethnic cohort study including 10 783 apparently healthy subjects of 6 different ethnicities (African Surinamese, Dutch, Ghanaian, Moroccan, South Asian Surinamese, and Turkish). Prevalence of STE‐ECGs across ethnicities, sexes, and age groups was assessed with respect to the 2 international STEMI thresholds: sex and age specific versus sex specific. Mean prevalence of STE‐ECGs was 2.8% to 3.4% (age/sex‐specific and sex‐specific thresholds, respectively), although with large ethnicity‐dependent variability. Prevalences in Western European Dutch were 2.3% to 3.0%, but excessively higher in young (<40 years) Ghanaian males (21.7%–27.5%) and lowest in older (≥40 years) Turkish females (0.0%). Ethnicity (sub‐Saharan African origin) and other variables (eg, younger age, male sex, high QRS voltages, or anterolateral early repolarization pattern) were positively associated with STE‐ECG occurrence, resulting in subgroups with >45% STE‐ECGs. Conclusions The accuracy of diagnostic tests partly relies on background prevalence in healthy individuals. In apparently healthy subjects, there is a highly variable ethnicity‐dependent prevalence of ECGs with ST‐segment elevations exceeding STEMI thresholds. This has potential consequences for STEMI evaluations in individuals who are not of Western European descent, putatively resulting in adverse outcomes with both over‐ and underdiagnosis of STEMI. Background Early prehospital recognition of critical conditions such as ST-segment-elevation myocardial infarction (STEMI) has prognostic relevance. Current international electrocardiographic STEMI thresholds are predominantly based on individuals of Western European descent. However, because of ethnic electrocardiographic variability both in health and disease, there is a need to reevaluate diagnostic ST-segment elevation thresholds for different populations. We hypothesized that fulfillment of ST-segment elevation thresholds of STEMI criteria (STE-ECGs) in apparently healthy individuals is ethnicity dependent. Methods and Results HELIUS (Healthy Life in an Urban Setting) is a multiethnic cohort study including 10 783 apparently healthy subjects of 6 different ethnicities (African Surinamese, Dutch, Ghanaian, Moroccan, South Asian Surinamese, and Turkish). Prevalence of STE-ECGs across ethnicities, sexes, and age groups was assessed with respect to the 2 international STEMI thresholds: sex and age specific versus sex specific. Mean prevalence of STE-ECGs was 2.8% to 3.4% (age/sex-specific and sex-specific thresholds, respectively), although with large ethnicity-dependent variability. Prevalences in Western European Dutch were 2.3% to 3.0%, but excessively higher in young (<40 years) Ghanaian males (21.7%-27.5%) and lowest in older (≥40 years) Turkish females (0.0%). Ethnicity (sub-Saharan African origin) and other variables (eg, younger age, male sex, high QRS voltages, or anterolateral early repolarization pattern) were positively associated with STE-ECG occurrence, resulting in subgroups with >45% STE-ECGs. Conclusions The accuracy of diagnostic tests partly relies on background prevalence in healthy individuals. In apparently healthy subjects, there is a highly variable ethnicity-dependent prevalence of ECGs with ST-segment elevations exceeding STEMI thresholds. This has potential consequences for STEMI evaluations in individuals who are not of Western European descent, putatively resulting in adverse outcomes with both over- and underdiagnosis of STEMI.Background Early prehospital recognition of critical conditions such as ST-segment-elevation myocardial infarction (STEMI) has prognostic relevance. Current international electrocardiographic STEMI thresholds are predominantly based on individuals of Western European descent. However, because of ethnic electrocardiographic variability both in health and disease, there is a need to reevaluate diagnostic ST-segment elevation thresholds for different populations. We hypothesized that fulfillment of ST-segment elevation thresholds of STEMI criteria (STE-ECGs) in apparently healthy individuals is ethnicity dependent. Methods and Results HELIUS (Healthy Life in an Urban Setting) is a multiethnic cohort study including 10 783 apparently healthy subjects of 6 different ethnicities (African Surinamese, Dutch, Ghanaian, Moroccan, South Asian Surinamese, and Turkish). Prevalence of STE-ECGs across ethnicities, sexes, and age groups was assessed with respect to the 2 international STEMI thresholds: sex and age specific versus sex specific. Mean prevalence of STE-ECGs was 2.8% to 3.4% (age/sex-specific and sex-specific thresholds, respectively), although with large ethnicity-dependent variability. Prevalences in Western European Dutch were 2.3% to 3.0%, but excessively higher in young (<40 years) Ghanaian males (21.7%-27.5%) and lowest in older (≥40 years) Turkish females (0.0%). Ethnicity (sub-Saharan African origin) and other variables (eg, younger age, male sex, high QRS voltages, or anterolateral early repolarization pattern) were positively associated with STE-ECG occurrence, resulting in subgroups with >45% STE-ECGs. Conclusions The accuracy of diagnostic tests partly relies on background prevalence in healthy individuals. In apparently healthy subjects, there is a highly variable ethnicity-dependent prevalence of ECGs with ST-segment elevations exceeding STEMI thresholds. This has potential consequences for STEMI evaluations in individuals who are not of Western European descent, putatively resulting in adverse outcomes with both over- and underdiagnosis of STEMI.
Author	Tanck, Michael W. T. Snijder, Marieke B. Maan, Arie C. ter Haar, C. Cato Postema, Pieter G. Peters, Ron J. G. de Jong, Jonas S. S. G. van den Born, Bert‐Jan H. Kors, Jan A. Swenne, Cees A. Macfarlane, Peter W.
AuthorAffiliation	1 Department of Cardiology Heart Center Amsterdam UMC University of Amsterdam The Netherlands 5 Department of Public Health Amsterdam Public Health research institute Amsterdam UMC University of Amsterdam The Netherlands 8 Institute of Health and Wellbeing University of Glasgow United Kingdom 6 Department of Vascular Medicine Amsterdam UMC University of Amsterdam Amsterdam the Netherlands 7 Onze Lieve Vrouwe Gasthuis, Heart Center Amsterdam The Netherlands 3 Department of Medical Informatics Erasmus MC University Medical Center Rotterdam The Netherlands 2 Department of Cardiology Heart‐Lung Center Leiden University Medical Center Leiden The Netherlands 4 Department of Clinical Epidemiology Biostatistics & Bioinformatics, Amsterdam Public Health Research Institute Amsterdam UMC University of Amsterdam The Netherlands
AuthorAffiliation_xml	– name: 2 Department of Cardiology Heart‐Lung Center Leiden University Medical Center Leiden The Netherlands – name: 1 Department of Cardiology Heart Center Amsterdam UMC University of Amsterdam The Netherlands – name: 3 Department of Medical Informatics Erasmus MC University Medical Center Rotterdam The Netherlands – name: 7 Onze Lieve Vrouwe Gasthuis, Heart Center Amsterdam The Netherlands – name: 6 Department of Vascular Medicine Amsterdam UMC University of Amsterdam Amsterdam the Netherlands – name: 4 Department of Clinical Epidemiology Biostatistics & Bioinformatics, Amsterdam Public Health Research Institute Amsterdam UMC University of Amsterdam The Netherlands – name: 8 Institute of Health and Wellbeing University of Glasgow United Kingdom – name: 5 Department of Public Health Amsterdam Public Health research institute Amsterdam UMC University of Amsterdam The Netherlands
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Snippet	Background Early prehospital recognition of critical conditions such as ST-segment-elevation myocardial infarction (STEMI) has prognostic relevance. Current... Background Early prehospital recognition of critical conditions such as ST‐segment–elevation myocardial infarction (STEMI) has prognostic relevance. Current...
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Title	Prevalence of ECGs Exceeding Thresholds for ST‐Segment–Elevation Myocardial Infarction in Apparently Healthy Individuals: The Role of Ethnicity
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