Electrocardiographic Abnormalities and Reclassification of Cardiovascular Risk: Insights from NHANES-III - 18/03/13
Requests for reprints should be addressed to Mauricio G. Cohen, MD, University of Miami Hospital, 1400 NW 12th Avenue, Suite 1179 Miami, FL 33136Abstract |
Background |
We aimed to assess the additive value of electrocardiogram (ECG) findings to risk prediction models for cardiovascular disease.
Methods |
Our dataset consisted of 6025 individuals with ECG data available from the National Health and Nutrition Examination Survey-III. This is a self-weighting sample with a follow-up of 79,046.84 person-years. The primary outcomes were cardiovascular mortality and all-cause mortality. We compared 2 models: Framingham Risk Score (FRS) covariates (Model A) and ECG abnormalities added to Model A (Model B), and calculated the net reclassification improvement index (NRI).
Results |
Mean age of our study population was 58.7 years; 45.6% were male and 91.7% were white. At baseline, 54.6% of individuals had ECG abnormalities, of which 545 (9%) died secondary to a cardiovascular event, compared with 194 individuals (3.2%) (P <.01) without ECG abnormalities. ECG abnormalities were significant predictors of cardiovascular mortality after adjusting for traditional cardiovascular risk factors (hazard ratio 1.44; 95% confidence interval, 1.13-1.83). Addition of ECG abnormalities led to an overall NRI of 3.6% subjects (P <.001) and 13.24% in the intermediate risk category. The absolute integrated discrimination index was 0.0001 (P <.001).
Conclusion |
Electrocardiographic abnormalities are independent predictors of cardiovascular mortality, and their addition to the FRS improves model discrimination and calibration. Further studies are needed to assess the prospective application of ECG abnormalities in cardiovascular risk prediction in individual subjects.
El texto completo de este artículo está disponible en PDF.Keywords : ECG screening, Epidemiology, Net reclassification index, Risk score
Esquema
| Funding: None. |
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| Conflicts of Interest: None. |
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| Authorship: All authors have contributed to the analysis design and oversight, manuscript conception and drafting, statistical analysis, or editorial review of the manuscript, and they have all read and approved the final manuscript. |
Vol 126 - N° 4
P. 319 - avril 2013 Regresar al número
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