Niu Jingya, Deng Chanjuan, Zheng Ruizhi, Xu Min, Lu Jieli, Wang Tiange, Zhao Zhiyun, Chen Yuhong, Wang Shuangyuan, Dai Meng, Xu Yu, Wang Weiqing, Ning Guang, Bi Yufang, Li Mian
Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, CN.
Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, CN.
Glob Heart. 2020 Sep 1;15(1):59. doi: 10.5334/gh.790.
To examine whether electrocardiography (ECG) could provide additional values to the traditional risk factors for cardiovascular disease (CVD) risk prediction among different cardiovascular risk subgroups.
A total of 7,872 community residents aged ≥40 years were followed up for a median of 4.5 years. A 12-lead resting ECG was examined for participants at baseline. CVD events including myocardial infarction, stroke and cardiovascular mortality were collected. Cox proportional hazards models were used and models of traditional risk factors with and without ECG were compared.
At baseline, 2,470 participants (31.3%) had ECG abnormalities. During follow-up, 464 participants developed CVD events. ECG abnormalities were associated with an increased risk of CVD after adjustment for the traditional risk factors in participants with a 10-year atherosclerotic CVD (ASCVD) risk ≥10% (hazard ratio, HR: 1.45; 95% confidence interval, CI: 1.11, 1.91). Adding ECG abnormalities to the traditional CVD risk factors improved reclassification for those who did not experience events [net reclassification index: 8.0% (95% CI: 2%, 19.5%)], discrimination (integrated discrimination improvement: 0.7% (95% CI: 0.1%, 1.9%), and calibration (goodness of fit P value from 0.600 to 0.873) in participants with a 10-year ASCVD risk ≥10%. However, no significant association and improvement were found in participants with a 10-year ASCVD risk <10%.
ECG screening might provide a marginal improvement in CVD risk prediction in adults at high risk. However, ECG should not be recommended in adults at low risk.
探讨心电图（ECG）能否为不同心血管风险亚组中预测心血管疾病（CVD）风险的传统危险因素提供额外价值。
共对7872名年龄≥40岁的社区居民进行了中位时间为4.5年的随访。在基线时对参与者进行12导联静息心电图检查。收集包括心肌梗死、中风和心血管死亡在内的CVD事件。使用Cox比例风险模型，并比较包含和不包含心电图的传统危险因素模型。
在基线时，2470名参与者（31.3%）存在心电图异常。在随访期间，464名参与者发生了CVD事件。在10年动脉粥样硬化性心血管疾病（ASCVD）风险≥10%的参与者中，调整传统危险因素后，心电图异常与CVD风险增加相关（风险比，HR：1.45；95%置信区间，CI：1.11，1.91）。对于未发生事件的参与者，将心电图异常添加到传统CVD危险因素中可改善重新分类[净重新分类指数：8.0%（95%CI：2%，19.5%）]、辨别力（综合辨别力改善：0.7%（95%CI：0.1%，1.9%））和校准（拟合优度P值从0.600到0.873），这些参与者的10年ASCVD风险≥10%。然而，在10年ASCVD风险<10%的参与者中未发现显著关联和改善。
心电图筛查可能会在高危成年人的CVD风险预测中带来边际改善。然而，不建议在低风险成年人中进行心电图检查。
