Prognosis – which is more decisive: angina or abnormal results on electrocardiogram
Sir,
Colleagues Hemingway et al. write about undiagnosed angina and its
prognosis. Abnormal results in resting electrocardiogram had a clear
impact on angina patients’ prognosis (non-fatal myocardial infarction and
all cause mortality) regardless of whether their angina had been diagnosed
or not. The authors state that “… we investigated each participant with a
resting 12 lead electrocardiogram at phases 1, 3, and 5”. Do I interpret
this correctly when I assume that electrocardiogram was recorded on all
participants, even those without angina? If so, what was the prognosis of
participants with abnormal electrocardiogram but no angina?
From the all type mortality table (Table 2) one can see that
mortality of angina patients without abnormal test results was not higher
than that of participants with no angina or myocardial infarction. Authors
do not state how high was the risk of non-fatal myocardial infarction of
angina patients without abnormality on electrocardiogram. Thus the poorer
prognosis seems to be connected to abnormality on electrocardiogram, not
angina as such. If we use angina questionnaire as a screening tool and
only when positive investigate with electrocardiogram, we miss the cases
with abnormal electrocardiogram but no angina. This is probably acceptable
and practical but if electrocardiogram was indeed carried out on all
participants (also those without angina) the authors might be able to shed
light on the amount of such persons and their prognosis in this kind of
setting.
Rapid Response:
Prognosis – which is more decisive: angina or abnormal results on electrocardiogram
Sir,
Colleagues Hemingway et al. write about undiagnosed angina and its
prognosis. Abnormal results in resting electrocardiogram had a clear
impact on angina patients’ prognosis (non-fatal myocardial infarction and
all cause mortality) regardless of whether their angina had been diagnosed
or not. The authors state that “… we investigated each participant with a
resting 12 lead electrocardiogram at phases 1, 3, and 5”. Do I interpret
this correctly when I assume that electrocardiogram was recorded on all
participants, even those without angina? If so, what was the prognosis of
participants with abnormal electrocardiogram but no angina?
From the all type mortality table (Table 2) one can see that
mortality of angina patients without abnormal test results was not higher
than that of participants with no angina or myocardial infarction. Authors
do not state how high was the risk of non-fatal myocardial infarction of
angina patients without abnormality on electrocardiogram. Thus the poorer
prognosis seems to be connected to abnormality on electrocardiogram, not
angina as such. If we use angina questionnaire as a screening tool and
only when positive investigate with electrocardiogram, we miss the cases
with abnormal electrocardiogram but no angina. This is probably acceptable
and practical but if electrocardiogram was indeed carried out on all
participants (also those without angina) the authors might be able to shed
light on the amount of such persons and their prognosis in this kind of
setting.
Yours sincerely
Juhani Jääskeläinen
GP, Tampere, Finland
Competing interests:
None declared
Competing interests: No competing interests