Yoshihisa Naruse1, Hiroshi Tada2, Yoshie Harimura1, Mayu Ishibashi1, Yuichi Noguchi1, Akira Sato1, Tomoya Hoshi1, Yukio Sekiguchi1, Kazutaka Aonuma1. 1. From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (Y.N., H.T., A.S., T.H., Y.S., K.A.); Cardiovascular Division, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan (Y.H., Y.N.); and Cardiovascular Division, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan (M.I.). 2. From the Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan (Y.N., H.T., A.S., T.H., Y.S., K.A.); Cardiovascular Division, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan (Y.H., Y.N.); and Cardiovascular Division, Ibaraki Prefectural Central Hospital, Kasama, Ibaraki, Japan (M.I.). htada@u-fukui.ac.jp.
Abstract
BACKGROUND: We recently showed that the presence of early repolarization (ER) increases the risk of ventricular fibrillation occurrences in the early phase of acute myocardial infarction (AMI). This study aimed to clarify whether an association exists between ER and occurrences of ventricular tachyarrhythmias or sudden death in the chronic phase of AMI. METHODS AND RESULTS: This study retrospectively enrolled 1131 patients (67±12 years; 862 men) with AMIs surviving 14 days post-AMI. The primary end point was the occurrence of sustained ventricular tachyarrhythmias or sudden death >14 days after the AMI onset. We evaluated the presence of ER from the predischarge ECG (mean 10±3 days post-AMI). ER was defined as an elevation of the terminal portion of the QRS complex of >0.1 mV in inferior or lateral leads. After a median follow-up of 26.2 months, 26 patients had an episode of ventricular tachyarrhythmias or sudden death. A multivariable Cox regression analysis revealed the presence of ER (hazard ratio, 5.37; 95% confidence interval, 2.27-12.69; P<0.001), Killip class on admission of >I (hazard ratio, 2.75; 95% confidence interval, 1.24-6.07; P=0.013), and a left ventricular ejection fraction of <35% (hazard ratio, 11.83; 95% confidence interval, 5.16-27.13; P<0.001) were significantly associated with event occurrences. As features of the ER pattern, ER in the inferior leads, high-amplitude ER, a notched morphology, and ER without ST-segment elevation were associated with an increased risk of event occurrences. CONCLUSIONS: ER observed at a mean of 10 days post-AMI may be a marker for a subsequent risk of ventricular tachyarrhythmias or sudden death.
BACKGROUND: We recently showed that the presence of early repolarization (ER) increases the risk of ventricular fibrillation occurrences in the early phase of acute myocardial infarction (AMI). This study aimed to clarify whether an association exists between ER and occurrences of ventricular tachyarrhythmias or sudden death in the chronic phase of AMI. METHODS AND RESULTS: This study retrospectively enrolled 1131 patients (67±12 years; 862 men) with AMIs surviving 14 days post-AMI. The primary end point was the occurrence of sustained ventricular tachyarrhythmias or sudden death >14 days after the AMI onset. We evaluated the presence of ER from the predischarge ECG (mean 10±3 days post-AMI). ER was defined as an elevation of the terminal portion of the QRS complex of >0.1 mV in inferior or lateral leads. After a median follow-up of 26.2 months, 26 patients had an episode of ventricular tachyarrhythmias or sudden death. A multivariable Cox regression analysis revealed the presence of ER (hazard ratio, 5.37; 95% confidence interval, 2.27-12.69; P<0.001), Killip class on admission of >I (hazard ratio, 2.75; 95% confidence interval, 1.24-6.07; P=0.013), and a left ventricular ejection fraction of <35% (hazard ratio, 11.83; 95% confidence interval, 5.16-27.13; P<0.001) were significantly associated with event occurrences. As features of the ER pattern, ER in the inferior leads, high-amplitude ER, a notched morphology, and ER without ST-segment elevation were associated with an increased risk of event occurrences. CONCLUSIONS: ER observed at a mean of 10 days post-AMI may be a marker for a subsequent risk of ventricular tachyarrhythmias or sudden death.
Authors: José M Di Diego; Bence Patocskai; Hector Barajas-Martinez; Virág Borbáth; Michael J Ackerman; Alexander Burashnikov; Jérôme Clatot; Gui-Rong Li; Victoria M Robinson; Dan Hu; Charles Antzelevitch Journal: PLoS One Date: 2020-11-24 Impact factor: 3.240