Association of early repolarization pattern on ECG with risk of cardiac and all-cause mortality: a population-based prospective cohort study (MONICA/KORA)

• Published in: PLoS medicine Vol. 7; no. 7; p. e1000314
• Main Authors: Sinner, Moritz F, Reinhard, Wibke, Müller, Martina, Beckmann, Britt-Maria, Martens, Eimo, Perz, Siegfried, Pfeufer, Arne, Winogradow, Janina, Stark, Klaus, Meisinger, Christa, Wichmann, H-Erich, Peters, Annette, Riegger, Günter A J, Steinbeck, Gerhard, Hengstenberg, Christian, Kääb, Stefan
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 01.07.2010; Public Library of Science (PLoS)
• Subjects: Adult; Aged; Analysis; Cardiovascular diseases; Cardiovascular Disorders/Arrhythmias, Electrophysiology, and Pacing; Case-Control Studies; Cause of Death; Cohort Studies; Diagnosis; Electrocardiogram; Electrocardiography; Electrocardiography - statistics & numerical data; Female; Germany; Heart Diseases - diagnosis; Heart Diseases - mortality; Humans; Male; Middle Aged; Patient outcomes; Population; Population Surveillance - methods; Prospective Studies; Public Health and Epidemiology; Risk; Risk factors; Time Factors; Germany; Prospective Studies; Humans; Middle Aged; Male; Risk; Case-Control Studies; Cause of Death; Time Factors; Heart Diseases; Electrocardiography; Adult; Female; Population; Aged; Population Surveillance; Germany; Cohort Studies
• ISSN: 1549-1676; 1549-1277; 1549-1676
• DOI: 10.1371/journal.pmed.1000314

Early repolarization pattern (ERP) on electrocardiogram was associated with idiopathic ventricular fibrillation and sudden cardiac arrest in a case-control study and with cardiovascular mortality in a Finnish community-based sample. We sought to determine ERP prevalence and its association with cardiac and all-cause mortality in a large, prospective, population-based case-cohort study (Monitoring of Cardiovascular Diseases and Conditions [MONICA]/KORA [Cooperative Health Research in the Region of Augsburg]) comprised of individuals of Central-European descent. Electrocardiograms of 1,945 participants aged 35-74 y, representing a source population of 6,213 individuals, were analyzed applying a case-cohort design. Mean follow-up was 18.9 y. Cause of death was ascertained by the 9th revision of the International Classification of Disease (ICD-9) codes as documented in death certificates. ERP-attributable effects on mortality were determined by a weighted Cox proportional hazard model adjusted for covariables. Prevalence of ERP was 13.1% in our study. ERP was associated with cardiac and all-cause mortality, most pronounced in those of younger age and male sex; a clear ERP-age interaction was detected (p = 0.005). Age-stratified analyses showed hazard ratios (HRs) for cardiac mortality of 1.96 (95% confidence interval [CI] 1.05-3.68, p = 0.035) for both sexes and 2.65 (95% CI 1.21-5.83, p = 0.015) for men between 35-54 y. An inferior localization of ERP further increased ERP-attributable cardiac mortality to HRs of 3.15 (95% CI 1.58-6.28, p = 0.001) for both sexes and to 4.27 (95% CI 1.90-9.61, p<0.001) for men between 35-54 y. HRs for all-cause mortality were weaker but reached significance. We found a high prevalence of ERP in our population-based cohort of middle-aged individuals. ERP was associated with about a 2- to 4-fold increased risk of cardiac mortality in individuals between 35 and 54 y. An inferior localization of ERP was associated with a particularly increased risk. Please see later in the article for the Editors' Summary.