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
- Davood Khalili1,2,
- Farzad Hadaegh1,
- Noushin Fahimfar1,
- Gita Shafiee1,
- Farhad Sheikholeslami1,
- Arash Ghanbarian1,
- Fereidoun Azizi3
- 1Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- 2Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- 3Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Correspondence to Dr Farzad Hadaegh, Associate professor of Internal Medicine and Endocrinology, Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Yaman Street, Velenjak, Tehran 19395-4763, Iran;
Contributors DK designed the study's analytic strategy, did some statistical analysis and contributed in writing the manuscript and interpreting the results. FH supervised the work, contributed in the study design, writing the manuscript and interpreting the results. NF did some statistical analysis and contributed in writing the manuscript and interpreting the results. GS prepared ECG data for analysis, contributed in statistical analysis and writing the manuscript. FS and AG contributed in study design and preparing outcome data and revised the manuscript critically. FA designed the study, directed its implementation and commented on the draft manuscript. All authors approved the manuscript to be published.
- Accepted 29 March 2012
- Published Online First 27 April 2012
Background To evaluate the power of abnormal resting ECG versus Rose Questionnaire angina and its additive value in predicting 10-year coronary heart disease (CHD) risk in an Iranian urban population with high prevalence of CHD.
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.
Results 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.
Conclusions Rose Questionnaire as a simple screening tool is equally important to predict incident CHD in both genders. Adding abnormal ECG to angina did not culminate in higher risk for future CHD events.
- Rose Questionnaire
- Minnesota coding
- Whitehall criteria
- coronary disease
- CHD/coronary heart
- public health
Funding This study was supported by grant No. 121 from the National Research Council of Iran.
Competing interests None.
Ethics approval Ethics approval was provided by the ethical committee of the Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Provenance and peer review Not commissioned; externally peer reviewed.