Does an electrocardiogram add predictive value to the rose angina questionnaire for future coronary heart disease? 10-year follow-up in a Middle East population
Journal of Epidemiology and Community Health, 05/29/2012
Exclusive author commentary
Khalili D et al. – Rose Questionnaire as a simple screening tool is equally important to predict incident coronary heart disease (CHD) in both genders. Adding abnormal ECG to angina did not culminate in higher risk for future CHD events.Methods
- There were 5101 subjects ≥30 years (2900 women), free of CHD at baseline; they were categorised in to four groups according to their Rose Angina and ECG status for ischaemia as Rose–/ECG–, Rose+/ECG–, Rose–/ECG+ and Rose+/ECG+.
- HR of CHD was estimated using Cox regression analysis, given Rose–/ECG– as the reference.
- The authors used Akaike information criterion, C–index and integrated discrimination improvement indices to evaluate the prognostic value of ECG when would be added to Rose Questionnaire.
- During follow–up, 387 CHD events (169 women) were observed.
- Multivariate analysis showed a HR of 2.59 (95% CI 1.71 to 3.91) and 2.26 (1.48 to 3.44) for Rose+/ECG– group in men and women, respectively.
- These figures for Rose–/ECG+ were 1.36 (0.90 to 2.05) in men and 2.09 (1.40 to 3.12) in women.
- There was no any interaction between Rose Questionnaire and gender to predict incident CHD, in age–adjusted analysis.
- Akaike information criterion, C–index and relative integrated discrimination improvement did not show any difference between models including Rose alone and Rose plus ECG to predict CHD events especially in men.
Hadaegh F. & Khalili D. (05/31/2012) comments:
We studied the importance of Rose Angina Questionnaire bearing in mind that a good medical history and physical examination are superior to any paraclinical exam. We found that Rose questionnaire is, at least, as important as ECG in predicting CHD events in future and ECG may not add any information acquired by using Rose. However it is saying that, we considered both major and minor ECG abnormalities which are predictive for incident CHD. Major ECG abnormalities are absolutely more important than minor ones but they are not prevalent and most of decisions are based on both major and minor ECG abnormalities.