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

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.