Additional Value of Early Repolarization Pattern in Prediction of Obstructive Coronary Artery Disease as Assessed by Coronary Angiography

Abstract

Recent reports show that an early repolarization pattern (ERP) is associated with a higher incidence of sudden cardiac death in patients with obstructive coronary artery disease (CAD). Sporadic case studies have pointed out that ERP might be related to obstructive CAD.In consecutive patients who had undergone coronary angiography, we investigated the relationship between ERP and obstructive CAD by evaluating its association with coronary artery stenosis.The study population consisted of 3785 patients (59.9% men; mean age 63.1 years) with or without obstructive CAD. Adjusting for major cardiovascular risk factors, ERP was significantly associated with obstructive CAD (adjusted odds ratio (OR): 2.24 [95% CI 1.70-2.95]) with an incremental predictive value (ROC AUC 0.76 versus 0.71, P = 0.02; NRI 55.3%, P < 0.001; IDI = 0.05, P = 0.008), specifically in subjects with low risk and intermediate risk. ERP also significantly improved the predictive value for multi-vessel disease (AUC: 0.77 versus 0.72, P = 0.02 for two-vessel disease; 0.79 versus 0.73, P = 0.04 for three-vessel disease). ERP was consistently associated with stenoses of 3 main coronary arteries.ERP is associated with significant increased risk for obstructive CAD.Further studies are warranted to confirm our results and to elucidate the specific pathogenic mechanisms.(Int Heart J 2019; 60: 296-302)

Association Between Temporal Changes in Early Repolarization Pattern With Long‐Term Cardiovascular Outcome: A Population‐Based Cohort Study

“…Fourth, our previous study and other reports have identified that ERP could be a marker of underlying structural heart diseases (ischemic, cardiomyopathy, etc) and not just a pure electrical phenomenon. 35 , 36 We thus performed sensitivity analyses by excluding subjects with coronary heart disease or chronic heart failure, but the results did not materially change. This might further corroborate our hypothesis that dynamic ERP could be an independent risk factor for cardiovascular outcomes.…”