Key result
Horizontal early repolarization linked to ~5-fold higher 60-month mortality vs normal ECG.
Why the study?
Early repolarization is a frequent indication, and evaluating the effects of its benign and malignant forms regarding prognosis is important.
Does early repolarization morphology and localization on electrocardiogram predict multi-vessel coronary artery disease, need for coronary bypass surgery, and 60-month mortality compared to a normal ECG population?
Cohort (n=786)
Two certified doctors who were blind to the research assessed the early repolarization diagnosis
No
Does early repolarization morphology and localization on electrocardiogram predict multi-vessel coronary artery disease, need for coronary bypass surgery, and 60-month mortality compared to a normal ECG population?
Horizontal and inferolateral early repolarization patterns on emergency department ECGs identify patients with significantly higher rates of severe multi-vessel coronary artery disease, surgical revascularization, and 5-year mortality, whereas ascending ER carries a benign prognosis comparable to normal ECGs.
Answers are grounded in this paper and cite their sources.
Horizontal ER may flag higher-risk ED patients for closer evaluation; leaves open whether morphology independently predicts outcomes in prospective cohorts.
Aim: Early repolarization (ER) is a frequent indication, and it is important to correctly evaluate the effects of its benign and malignant forms in terms of prognosis. It was aimed to compare ER cases with the normal population in terms of multi-vessel disease, bypass and mortality. Material and Method: This study comprised 776 patients aged 18 and older who admitted the emergency department between January 2015 and December 2020. 377 of these patients had ER in the electrocardiogram (ECG), 409 patients had normal ECGs and were added to the study as the control group. Age, gender, multi-vessel disease, by-pass and mortality relations of the patients were evaluated with angiographic findings. Results: The mean age of 786 patients was 50.49±6.82 years, 372 (47.3%) were female, and the age range was 23-66 years (p<0.001). Of the cases, 110 (14%) were in the horizontal ER, 267 (34%) were in the ascending ER, and 409 (52%) were in the normal group. Multi-vessel disease was observed in 58 (7.4%) of all cases (p<0.001), while 19 (2.4%) had a by-pass attempt because angiography could not be cured (p=0.001). Of the cases with early repolarization, 176 (22.4%) were inferior, 112 (14.2%) were inferolateral, 77 (9.8%) were anterior, and a small number of them were 12 (1.5%) common ER types (p<0.001). Angiography was normal in 575 (73.2%) cases, left anterior descending artery was occluded in 65 (8.3%), circumflex artery was occluded in 73 (9.3%) and right coronary artery was occluded in 73 (9.3%) cases (p<0.001). Eighteen (2.3%) patients resulted in mortality in the 60-month follow-up of all cases. Of these, 9 (8.2%) were horizontal, 2 (0.7%) were asending, and 7 (1.7%) were in the normal population (p<0.001). Conclusion: Electrocardiography can be a helpful method to evaluate interventional angiography, prognosis and mortality in both early repolarization cases and normal cases.
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Öztürk et al. (2023) conducted a cohort in Early repolarization (ER) on electrocardiogram (ECG) (n=786). Early repolarization (ER) on electrocardiogram (horizontal and ascending morphologies) vs. Normal electrocardiogram (ECG) population was evaluated on All-cause mortality at 60-month follow-up (p=<0.001). Horizontal early repolarization on ECG was associated with higher 60-month mortality and multi-vessel disease than ascending ER or normal ECG.
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