Prognostic value of electrocardiographic abnormalities in adults from the Brazilian longitudinal study of adults' health
Prognostic value of electrocardiographic abnormalities in adults from the Brazilian longitudinal study of adults' health
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DOI：
10.1136/heartjnl-2020-318097
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发表时间：
2021-10-01
期刊：
影响因子：
5.7
通讯作者：
Ribeiro, Antonio Luiz Pinho
中科院分区：
文献类型：
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作者：
Pinto-Filho, Marcelo Martins;Brant, Luisa Caldeira;Ribeiro, Antonio Luiz Pinho
目的心血管疾病是高度可预防的非传染性疾病。心电图是心血管疾病风险分层的潜在工具。我们的目的是评估心电图在全因死亡率和心血管死亡率预测中的作用。方法来自巴西成人健康纵向研究的参与者，基线时无已知心血管疾病。在基线（2008-2010）进行12导联心电图检查。在2018年之前，参与者每年都会接受采访。对死亡进行了独立审查。Cox以及Fine和Grey多变量回归模型被应用于评估是否存在任何主要的心电图异常（MEA），根据明尼苏达法典系统定义，将预测总死亡和心血管死亡。我们还评估了将MEA加入系统冠状动脉风险评估（SCORE）的净重分类指数。结果13428例参与者（中位年龄51岁，男性45%）随访8±1年。全因死亡率和心血管死亡率分别占人口的2.8%和1.2%。在调整年龄、种族、教育程度和传统心血管危险因素后，流行MEA是总体（HR=2.3, 95% CI 1.7 ~ 2.9）和心血管死亡率（HR=4.6, 95% CI 3.0 ~ 7.0）的独立预测因子。将MEA添加到SCORE中，在无事件亚组中有9%的错误重新分类，在有致命心血管事件的亚组中有33%的正确重新分类。结论MEA的存在是总体死亡率和心血管死亡率的独立预测因子。在初级保健中，心电图可能在心血管疾病死亡率的风险预测中起作用。
Objective Cardiovascular diseases (CVDs) are highly preventable non-communicable diseases. ECG is a potential tool for risk stratification with respect to CVD. Our aim was to evaluate ECG's role in all-cause and cardiovascular mortality prediction. Methods Participants from the Brazilian Longitudinal Study of Adult Health, free of known CVD at baseline were included. A 12-lead ECG was obtained at baseline (2008-2010). Participants were followed up to 2018 by annual interviews. Deaths were independently reviewed. Cox as well as Fine and Grey multivariable regression models were applied to evaluate if the presence of any major electrocardiographic abnormality (MEA), defined according to the Minnesota Code system, would predict total and cardiovascular deaths. We also evaluated the Net Reclassification Index of adding MEA to the Systematic Coronary Risk Evaluation (SCORE). Results The 13 428 participants (median age 51 years, 45% men) were followed up for 8 +/- 1 years. All-cause and cardiovascular mortality occurred in 2.8% and 1.2% of the population, respectively. Prevalent MEA was an independent predictor of overall (HR=2.3, 95% CI 1.7 to 2.9) and cardiovascular mortality (HR=4.6, 95% CI 3.0 to 7.0) after adjustments for age, race, education and traditional cardiovascular risk factors. Adding MEA to the SCORE resulted in 9% mis-reclassification in the non-event subgroup and 33% correct reclassification in those with a fatal cardiovascular event. Conclusion Presence of MEA was an independent predictor of overall and cardiovascular mortality. ECG may have a role in risk prediction of cardiovascular mortality in primary care.