Long-term prognostic significance of the ST level and ST slope in the 12-lead ECG in the general population

Abstract Background Even minor ST depression in the electrocardiogram (ECG) is associated with cardiovascular disease and increased mortality. There is limited data on the prognostic significance of ST-level changes in the general population. Subjects and methods A random sample of Finnish subjects (n = 6354) aged over 30 years (56.1% women) underwent a health examination including a 12‑lead ECG in the Health 2000 survey. The effects of relative ST level as a continuous variable and ST slope (upsloping, horizontal, downsloping) in three different lead groups were analyzed using a multi-adjusted Cox proportional hazard model separately for men and women with total mortality as endpoint. Results The follow-up lasted for 13.7 (SD 3.3) years for men and 13.9 (SD 3.1) years for women. Lower lateral ST levels were associated with all-cause mortality in multi-adjusted models in both genders (at J + 80 ms hazard ratio [HR] 0.64 for a change of 1.0 mm [95% confidence interval 0.49–0.84, p = 0.002] for men and HR 0.61 [0.48–0.78, p  Conclusion Lower ST level in the lateral ECG leads is an independent prognostic factor to predict all-cause mortality in the general population.