title: Microalbuminuria modifies the mortality risk associated with electrocardiographic ST-T segment changes.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Clinical Pharmacology, University of Groningen, Groningen, The Netherlands. g.f.h.diercks@med.rug.nl
authors.forename: Gilles F H
authors.initials: GF
authors.lastname: Diercks
authors.forename: Hans L
authors.initials: HL
authors.lastname: Hillege
authors.forename: Ad J
authors.initials: AJ
authors.lastname: van Boven
authors.forename: Jan A
authors.initials: JA
authors.lastname: Kors
authors.forename: Harry J G M
authors.initials: HJ
authors.lastname: Crijns
authors.forename: Diederick E
authors.initials: DE
authors.lastname: Grobbee
authors.forename: Paul E
authors.initials: PE
authors.lastname: de Jong
authors.forename: Wiek H
authors.initials: WH
authors.lastname: van Gilst
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000453:epidemiology*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000401:mortality*; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors