What is the clinical evidence from this study?

Study design: Cohort. Population: General population (n=7630). Intervention: J-point elevation ≥ 0.1 mV vs. No J-point elevation. Primary outcome: Death from coronary artery disease (HR 4.66, 95% CI 2.30-9.46, p=<0.001).

January 1, 2013Open Access

Association Between J-Point Elevation and Death From Coronary Artery Disease

Q: What are the key findings of this study?

J-point elevation on standard 12-lead ECG was associated with a significantly increased risk of death from coronary artery disease (HR 4.66) compared to individuals without J-point elevation.

Key Result

J-point elevation on standard 12-lead ECG was associated with a significantly increased risk of death from coronary artery disease (HR 4.66) compared to individuals without J-point elevation.

Study Design

Type

Cohort (n=7,630)

Multicenter

Yes

Structured PICO

Does the presence of J-point elevation on 12-lead ECG predict cardiac death and death from CAD in a general population?

Population

7,630 individuals from a representative general Japanese population (41% men, mean age 52.4 years) participating in the National Survey of Circulatory Disorders.

Intervention

Presence of J-point elevation ≥0.1 mV on standard 12-lead ECG

Comparator

Absence of J-point elevation ≥0.1 mV

Outcome

Cardiac death and death from coronary artery disease (CAD)hard clinical

J-point elevation ≥0.1 mV on a standard 12-lead ECG is an independent predictor of cardiac death and CAD-related death in the general Japanese population, especially in middle-aged individuals.

Main Result

Effect estimate: HR 4.66 (95% CI 2.30-9.46)

Absolute Event Rate: 4.2% vs 0.8%

p-value: p=<0.001

Limitations

Small number of deaths to comprehensively analyze the prognostic significance of arrhythmia associated with J-point elevation
Lack of incidence data to examine differences between incidence and mortality
Use of death certificate data may lead to misclassification in the cause of death
Uncertainty around the cause of death from CAD other than acute MI
Lack of detailed information on the amplitude or morphology of the J-point elevation

Abstract

BACKGROUND: An early repolarization pattern, characterized by an elevation of the QRS-ST junction (J-point) on 12-lead electrocardiography (ECG) is associated with cardiac and sudden death. However, little is known about the prognostic significance of J-point elevation for various disease-specific cardiovascular outcomes, including coronary artery disease (CAD). METHODS AND RESULTS: To investigate the association between the presence of J-point elevation≥0.1 mV and various disease-specific cardiovascular outcomes, we conducted a 15-year prospective study in a representative general Japanese population of 7,630 individuals (41% men, mean age 52.4 years) who participated in the National Survey of Circulatory Disorders. Cox models were used to estimate the hazard ratios (HRs) adjusted for possible confounding factors. J-point elevation was present in 264 individuals (3.5%) and was associated with an increased risk of cardiac death (adjusted HR, 2.54; 95% confidence interval CI 1.40-4.58; P=0.002) and death from CAD (adjusted HR, 4.66; 95% CI 2.30-9.46; P<0.001). In a subgroup analysis by age, the association between J-point elevation and cardiovascular outcomes was more remarkable in middle-aged (<60 years) than in older individuals (≥60 years) (all P for interaction<0.05). CONCLUSIONS: J-point elevation on standard 12-lead ECG was an independent predictor of cardiac death and death from CAD in a representative sample of the general Japanese population, particularly among the middle-aged.

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