Microalbuminuria modifies the mortality risk associated with electrocardiographic ST-T segment changes

Gilles F.H. Diercks, Hans L. Hillege, A. d.J. Van Boven, Jan A. Kors, Harry J.G.M. Crijns, Diederick E. Grobbee, Paul E. De Jong, Wiek H. Van Gilst

Research output: Contribution to journalArticleAcademicpeer-review

43 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)1401-1407
Number of pages7
JournalJournal of the American College of Cardiology
Volume40
Issue number8
DOIs
Publication statusPublished - 16 Oct 2002

Fingerprint

Dive into the research topics of 'Microalbuminuria modifies the mortality risk associated with electrocardiographic ST-T segment changes'. Together they form a unique fingerprint.

Cite this