November 16, 2009New England Journal of Medicine852 citationsOpen Access
Long-Term Outcome Associated with Early Repolarization on Electrocardiography
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Key Result
Early repolarization with J-point elevation ≥0.1 mV in inferior leads was associated with an increased risk of cardiac death (RR 1.28; 95% CI 1.04-1.59; P=0.03) over a mean 30-year follow-up.
Key Points
- The aim is to determine the long-term prognostic significance of early repolarization in a general population.
- Community-based assessment of 10,864 middle-aged subjects (mean age 44 years)
- Evaluated early repolarization patterns on 12-lead electrocardiography
- Follow-up duration was a mean of 30 years
- Early repolarization (≥0.1 mV) was present in 630 subjects (5.8%), with an adjusted relative risk of 1.28 for death from cardiac causes (P=0.03).
- J-point elevation >0.2 mV in inferior leads associated with an adjusted relative risk of 2.98 for cardiac death (P<0.001) and 2.92 for arrhythmia (P=0.01).
- Prolonged QT interval and left ventricular hypertrophy were weaker predictors than early repolarization.
Study Design
Type
Cohort (n=10,864)
Structured PICO
Does early repolarization on electrocardiography predict death from cardiac causes in a middle-aged general population?
P
Population
10,864 middle-aged subjects from a community-based general population, mean age 44+/-8 years.
I
Intervention
Presence of early repolarization pattern (J-point elevation ≥0.1 mV or >0.2 mV in inferior or lateral leads) on 12-lead electrocardiography
O
Outcome
Death from cardiac causes during a mean follow-up of 30+/-11 yearshard clinical
An early-repolarization pattern in the inferior leads on a standard ECG is associated with an increased long-term risk of cardiac death in middle-aged individuals.
Main Result
Effect estimate: RR 1.28 (95% CI 1.04 to 1.59)
p-value: p=0.03
Abstract
BACKGROUND: Early repolarization, which is characterized by an elevation of the QRS-ST junction (J point) in leads other than V(1) through V(3) on 12-lead electrocardiography, has been associated with vulnerability to ventricular fibrillation, but little is known about the prognostic significance of this pattern in the general population. METHODS: We assessed the prevalence and prognostic significance of early repolarization on 12-lead electrocardiography in a community-based general population of 10,864 middle-aged subjects (mean +/-SD age, 44+/-8 years). The primary end point was death from cardiac causes, and secondary end points were death from any cause and death from arrhythmia during a mean follow-up of 30+/-11 years. Early repolarization was stratified according to the degree of J-point elevation (> or = 0.1 mV or > 0.2 mV) in either inferior or lateral leads. RESULTS: The early-repolarization pattern of 0.1 mV or more was present in 630 subjects (5.8%): 384 (3.5%) in inferior leads and 262 (2.4%) in lateral leads, with elevations in both leads in 16 subjects (0.1%). J-point elevation of at least 0.1 mV in inferior leads was associated with an increased risk of death from cardiac causes (adjusted relative risk, 1.28; 95% confidence interval CI, 1.04 to 1.59; P=0.03); 36 subjects (0.3%) with J-point elevation of more than 0.2 mV in inferior leads had a markedly elevated risk of death from cardiac causes (adjusted relative risk, 2.98; 95% CI, 1.85 to 4.92; P<0.001) and from arrhythmia (adjusted relative risk, 2.92; 95% CI, 1.45 to 5.89; P=0.01). Other electrocardiographic risk markers, such as a prolonged QT interval corrected for heart rate (P=0.03) and left ventricular hypertrophy (P=0.004), were weaker predictors of the primary end point. CONCLUSIONS: An early-repolarization pattern in the inferior leads of a standard electrocardiogram is associated with an increased risk of death from cardiac causes in middle-aged subjects.
Cite This Study
Tikkanen et al. (2009) conducted a cohort in General population (n=10,864). Early repolarization (J-point elevation ≥0.1 mV in inferior leads) vs. Absence of early repolarization was evaluated on Death from cardiac causes (RR 1.28, 95% CI 1.04 to 1.59, p=0.03). Early repolarization with J-point elevation ≥0.1 mV in inferior leads was associated with an increased risk of cardiac death (RR 1.28; 95% CI 1.04-1.59; P=0.03) over a mean 30-year follow-up.