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J Am Coll Cardiol, 2002; 40:1401-1407 © 2002 by the American College of Cardiology Foundation |
* Department of Clinical Pharmacology, University of Groningen, Groningen, The Netherlands
Department of Cardiology, Academic Hospital, Groningen, The Netherlands
Department of Medical Informatics, Erasmus University, Rotterdam, The Netherlands
Julius Center for Patient Oriented Research, University Medical Center, Utrecht, The Netherlands
|| Department of Nephrology, Academic Hospital, Groningen, The Netherlands
Manuscript received January 22, 2002; revised manuscript received May 28, 2002, accepted June 7, 2002.
* Reprint requests and correspondence: Dr. Gilles F. H. Diercks, Department of Clinical Pharmacology, University of Groningen, A. Deusinglaan 1, 9713 AV, Groningen, The Netherlands.
g.f.h.diercks{at}med.rug.nl
OBJECTIVES: We sought to investigate whether microalbuminuria, a proposed marker of generalized vascular damage, enhances the prognostic value of ST-T segment changes for all-cause and cardiovascular mortality in the general population.
BACKGROUND: ST-T segment changes on the rest electrocardiogram (ECG) predict mortality in the general population. However, the excess risk seems to be low, particularly in nonhospitalized populations with a low cardiovascular risk profile.
METHODS: In a population of 7,330 male and female subjects, a total of 89 deaths (1.2%) occurred during a median three-year follow-up. In 69 of these, the cause of death was obtained from the Central Bureau of Statistics: 25 subjects died of cardiovascular causes (36%). Using computerized Minnesota coding, ST-T segment changes were coded as 4.1-4 and 5.1-4. Microalbuminuria was defined as a urinary albumin excretion of 30 to 300 mg per 24 h.
RESULTS: The combination of ST-T segment changes and microalbuminuria showed a higher hazard ratio (HR) for all-cause mortality (HR 8.6 [95% confidence interval [CI] 4.8 to 15.2, p < 0.0001), as compared with ST-T segment changes in the absence of microalbuminuria (HR 1.3 [95% CI 0.7 to 2.5]), which was independent of other cardiovascular risk factors (HR 3.3 [95% CI 1.5 to 7.1], p = 0.002). The combination showed a higher HR when only cardiovascular deaths were taken into account, as compared with all-cause mortality (HR 24.5 [95% CI 7.9 to 76.0], p < 0.0001), which also counted for ST-T segment changes alone (HR 4.4 [95% CI 1.4 to 14.5], p = 0.02). After controlling for other risk factors, the HRs were 10.4 (95% CI 2.5 to 43.6, p = 0.001) for the combination and 2.7 (95% CI 0.6 to 12.3) for ST-T segment changes alone.
CONCLUSIONS: This study suggests that, in subjects with ST-T segment changes on their rest ECG, microalbuminuria could identify those at increased risk of all-cause and cardiovascular mortality.
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