Electrocardiographic Changes Improve Risk Prediction in Asymptomatic Persons Age 65 Years or Above Without Cardiovascular Disease
Electrocardiographic Changes Improve Risk Prediction in Asymptomatic Persons Age 65 Years or Above Without Cardiovascular Disease
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DOI：
10.1016/j.jacc.2014.05.050
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发表时间：
2014-09-02
影响因子：
24
通讯作者：
Mogelvang, Rasmus
中科院分区：
文献类型：
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作者：
Jorgensen, Peter Godsk;Jensen, Jan S.;Mogelvang, Rasmus
背景 由于预期寿命更长，老年患者的风险预测变得越来越重要。 目的 本研究旨在探讨心电图 (ECG) 变化是否可以为当前风险模型和传统风险因素提供增量的预后信息。 方法 总共纳入了来自哥本哈根心脏研究的 6,991 名年龄 >= 65 岁参加检查的参与者。根据明尼苏达规范，心电图改变被定义为 Q 波、ST 段压低、T 波改变、心室传导缺陷和左心室肥厚。主要终点是致命性心血管疾病（CVD）事件，次要终点是致命或非致命性CVD事件。在我们的研究中，在平均 11.9 年和 9.8 年的随访期间，发生了 2,236 例致命性 CVD 事件和 3,849 例致命或非致命性 CVD 事件。 结果 心电图变化频繁出现 (30.6%)，并且与传统危险因素相关。除 1 项外，所有心电图变化均单变量预测两个终点。心电图改变与无心电图改变的事件发生率分别为 41.4% 与 27.8% 以及 64.6% 与 50.8%。当添加到现有风险评分中时，心电图变化独立地增加了两个终点的风险。致命 CVD 事件：风险比 (HR)：1.33（95% 置信区间 [CI]：1.29 至 1.36；p < 0.001），致命或非致命 CVD 事件：HR：1.21（95% CI：1.19 至 1.24；p < 0.001）。添加到常规危险因素后，致命事件的连续净重新分类改善率为 42.3%（95% CI：42.0 至 42.4；p < 0.001），致命或非致命事件的连续净重新分类改善率为 29.2%（95% CI：28.4 至 29.2；p < 0.001）。致命事件的分类净重新分类为 7.1%（95% CI：6.7 至 9.0；p < 0.001），致命或非致命事件的分类净重新分类为 4.2%（95% CI：3.5 至 5.6；p < 0.001）。 结论 对心电图变化的存在进行简单评估可提高年龄 >= 65 岁一般人群的风险预测。 (C) 2014 年，美国心脏病学会基金会。
BACKGROUND Risk prediction in elderly patients is increasingly relevant due to longer life expectancy.OBJECTIVES This study sought to examine whether electrocardiographic (ECG) changes provide prognostic information incremental to current risk models and to the conventional risk factors.METHODS In all, 6,991 participants from the Copenhagen Heart Study attending an examination at age >= 65 years were included. ECG changes were defined as Q waves, ST-segment depression, T-wave changes, ventricular conduction defects, and left ventricular hypertrophy based on the Minnesota code. The primary endpoint was fatal cardiovascular disease (CVD) event and the secondary was fatal or nonfatal CVD event. In our study, 2,236 fatal CVD and 3,849 fatal or nonfatal CVD events occurred during a median of 11.9 and 9.8 years of follow-up.RESULTS ECG changes were frequently present (30.6%) and associated with conventional risk factors. All ECG changes except 1 univariably predicted both endpoints. Event rates of ECG changes versus no ECG changes were respectively 41.4% versus 27.8% and 64.6% versus 50.8%. When added to existing risk scores, ECG changes independently increased the risk of both endpoints. Fatal CVD events: hazard ratio (HR): 1.33 (95% confidence interval [CI]: 1.29 to 1.36; p < 0.001) and fatal or nonfatal CVD events: HR: 1.21 (95% CI: 1.19 to 1.24; p < 0.001). When added to conventional risk factors, continuous net reclassification improvement was 42.3% (95% CI: 42.0 to 42.4; p < 0.001) for fatal and 29.2% (95% CI: 28.4 to 29.2; p < 0.001) for fatal or nonfatal events. Categorical net reclassification was 7.1% (95% CI: 6.7 to 9.0; p < 0.001) for fatal and 4.2% (95% CI: 3.5 to 5.6; p < 0.001) for fatal or nonfatal events.CONCLUSIONS Simple assessment of the existence of ECG changes improves risk prediction in the general population of persons age >= 65 years. (C) 2014 by the American College of Cardiology Foundation.