Predictive value of combined electrocardiographic and echocardiographic parameters for major adverse cardiovascular events in patients with established coronary artery disease: a single-center retrospective cohort study.

OBJECTIVE: To explore the predictive value of combining conventional ECG parameters (P-wave dispersion, Sokolow-Lyon voltage) and echocardiographic parameters (left atrial volume index, LAVI) for major adverse cardiovascular events (MACE) in coronary artery disease (CAD) patients. METHODS: From January 2024 to February 2026, 306 angiographically confirmed CAD patients were enrolled. All underwent standard 12-lead ECG and transthoracic echocardiography at admission. Over a median follow-up of 15.2 months, 50 patients developed MACE and 256 remained event-free. Baseline ECG (P-wave dispersion, QTc, Sokolow-Lyon voltage) and echocardiographic parameters (LAVI, left ventricular ejection fraction, left ventricular mass index) were compared. Independent predictors were identified by multivariate Cox regression, and a combined model was built. Incremental value was assessed by C-index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). The study was approved by the institutional review board. RESULTS: The MACE group had higher P-wave dispersion, LAVI, and left ventricular mass index, and lower Sokolow-Lyon voltage and LVEF (all p < 0.05). After multivariate adjustment, increased P-wave dispersion and greater LAVI were independent predictors of MACE (both p < 0.05). The combination model (P-wave dispersion + LAVI) significantly outperformed the basic clinical model (age, sex, diabetes, prior MI, eGFR) in risk discrimination (C-index, NRI, IDI all p < 0.05). Sensitivity analyses confirmed robustness. CONCLUSION: Routinely available ECG-derived P-wave dispersion and echocardiographic LAVI are independent, complementary predictors of MACE in CAD patients. Integrating these two parameters into a simple risk model significantly enhances risk discrimination and reclassification, providing a practical, cost-effective tool for individualized management.