Abstract P122: P-wave Axis is Associated With All-Cause Mortality in Diabetes: The ACCORD Trial

Abstract

Introduction: Abnormal P-wave axis (PWA) has emerged as a novel marker of risk for both cardiovascular disease and all-cause mortality in the general population, though this relationship has not been adequately explored among those with type 2 diabetes. Hypothesis: We hypothesized that abnormal PWA is associated with all-cause mortality in a large, well-phenotyped group of participants with type 2 diabetes from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. Methods: This analysis included 8,899 ACCORD participants with available PWA data on baseline electrocardiogram. Cox proportional hazards models were used to examine the association between PWA and ACM in models adjusted for demographics, ACCORD trial treatment assignment, and potential confounders. PWA was modeled as either normal (0° - 75°) or abnormal (<0° or >75°). We evaluated the predictive value of PWA by comparing area under the receiver operating characteristic curves in models with and without PWA. Results: Over 44,000 person-years, there were 609 deaths. Participants with abnormal PWA had increased risk of all-cause mortality (HR 1.61, 95% CI 1.25 – 2.08). After multivariable adjustment, the association remained significant (HR 1.32, 95% CI 1.02 – 1.71; see TABLE). Inclusion of abnormal PWA in prediction models afforded a small increase in area under the receiver operating characteristic curves (AUC 0.653 vs. 0.643, p-value for difference of 0.002). Conclusions: In conclusion, among ACCORD trial participants, abnormal PWA was associated with an increased risk of mortality. Abnormal PWA may have added value beyond traditional risk factors in prediction models.