Long-Term Mortality Risk in Individuals With Atrial or Ventricular Premature Complexes (Results from the Third National Health and Nutrition Examination Survey)

Premature ectopic beats are frequently detected on routine 12-lead screening electrocardiograms (ECGs). However, their prognostic importance in subjects without known cardiovascular disease (CVD) is not well established. We evaluated prognostic value of atrial premature complexes (APCs) and ventricular premature complexes (VPCs) detected by a single 12-lead electrocardiography. A prospective cohort of 7,504 participants selected from nationally representative community-dwelling subjects living in the United States, enrolled in the Third National Health and Nutrition Examination Survey III from 1988 to 1994 with follow-up through December 2006 without known CVD. The main outcomes were all-cause mortality, CVD-related mortality, and ischemic heart disease (IHD)-related mortality. Of 7,504 participants (mean age 60 ± 14 years, 47% women, 49% whites), 89 (1.2%) had APCs and 110 (1.5%) had VPCs on 12-lead ECGs. During a follow-up of up to 18 years, 2,386 deaths occurred, of which 963 were due to CVD and 511 were due to IHD. In a multivariate analysis adjusted for demographics, clinical variables, and electrocardiographic measures, APCs were significantly associated with all-cause mortality (hazard ratio [HR] 1.41, 95% confidence interval [CI] 1.08 to 1.80), CVD death (HR 1.78, 95% CI 1.26 to 2.44), and IHD death (HR 2.40, 95% CI 1.59 to 3.47). For VPCs, however, there were no significant associations with all-cause mortality (HR 1.05, 95% CI 0.80 to 1.36), CVD death (HR 0.96, 95% CI 0.62 to 1.43), and IHD death (HR 0.89, 95% CI 0.47 to 1.52). In conclusion, APCs, but not VPCs, on routine screening ECGs are predictive of adverse events in community-dwelling subjects without known CVD.