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Electrocardiographic and clinical predictors separating atherosclerotic sudden cardiac death from incident coronary heart disease.
Tuesday,2012-11-06 12:25 America/Los_Angeles — eenright
| Title | Electrocardiographic and clinical predictors separating atherosclerotic sudden cardiac death from incident coronary heart disease. |
| Publication Type | Journal Article |
| Year of Publication | 2011 |
| Authors | Soliman, EZ, Prineas, RJ, L Case, D, Russell, G, Rosamond, W, Rea, T, Sotoodehnia, N, Post, WS, Siscovick, D, Psaty, BM, Burke, GL |
| Journal | Heart |
| Volume | 97 |
| Issue | 19 |
| Pagination | 1597-601 |
| Date Published | 2011 Oct |
| ISSN | 1468-201X |
| Keywords | Adult, Aged, Aged, 80 and over, Body Mass Index, Continental Population Groups, Coronary Disease, Death, Sudden, Cardiac, Electrocardiography, Ethnic Groups, Female, Heart Rate, Humans, Hypertension, Male, Middle Aged, Predictive Value of Tests, Prognosis, Proportional Hazards Models, Risk Adjustment, Risk Factors, Time Factors, United States |
| Abstract | <p><b>OBJECTIVE: </b>To identify specific ECG and clinical predictors that separate atherosclerotic sudden cardiac death (SCD) from incident coronary heart disease (CHD) (non-fatal events and non-sudden death) in the combined cohorts of the Atherosclerosis Risk in Communities study and the Cardiovascular Health Study.</p><p><b>METHODS: </b>This analysis included 18,497 participants (58% females, 24% black individuals, mean age 58 years) who were initially free of clinical CHD. A competing risk analysis was conducted to examine the prognostic significance of baseline clinical characteristics and an extensive electronic database of ECG measurements for prediction of 229 cases of SCD as a first event versus 2297 incident CHD cases (2122 non-fatal events and 175 non-sudden death) that occurred during a median follow-up time of 13 years in the Cardiovascular Health Study and 14 years in the Atherosclerosis Risk in Communities study.</p><p><b>RESULTS: </b>After adjusting for common CHD risk factors, a number of clinical characteristics and ECG measurements were independently predictive of SCD and CHD. However, the risk of SCD versus incident CHD was significantly different for race/ethnicity, hypertension, body mass index (BMI), heart rate, QTc, abnormally inverted T wave in any ECG lead group and level of ST elevation in V2. Black race/ethnicity (compared to non-black) was predictive of high SCD risk but less risk of incident CHD (p value for differences in the risk (HR) for SCD versus CHD <0.0001). Hypertension, increased heart rate, prolongation of QTc and abnormally inverted T wave were stronger predictors of high SCD risk compared to CHD (p value=0.0460, 0.0398, 0.0158 and 0.0265, respectively). BMI was not predictive of incident CHD but was predictive of high SCD risk in a quadratic fashion (p value=0.0220). On the other hand, elevated ST height as measured at the J point and that measured at 60 ms after the J point in V2 were not predictive of SCD but were predictive of high incident CHD risk (p value=0.0251 and 0.0155, respectively).</p><p><b>CONCLUSIONS: </b>SCD and CHD have many risk factors in common. Hypertension, race/ethnicity, BMI, heart rate, QTc, abnormally inverted T wave in any ECG lead group and level of ST elevation in V2 have the potential to separate between the risks of SCD and CHD. These results need to be validated in another cohort.</p> |
| DOI | 10.1136/hrt.2010.215871 |
| Alternate Journal | Heart |
| PubMed ID | 21775508 |
| PubMed Central ID | PMC3638973 |
| Grant List | HHSN268201100012C / HL / NHLBI NIH HHS / United States HHSN268201100009I / HL / NHLBI NIH HHS / United States N01-HC-85085 / HC / NHLBI NIH HHS / United States HHSN268201100010C / HL / NHLBI NIH HHS / United States HHSN268201100008C / HL / NHLBI NIH HHS / United States U01 HL080295 / HL / NHLBI NIH HHS / United States HHSN268201100005G / HL / NHLBI NIH HHS / United States HHSN268201100008I / HL / NHLBI NIH HHS / United States N01-HC-85081 / HC / NHLBI NIH HHS / United States HHSN268201100005C / / PHS HHS / United States HHSN268201100007C / HL / NHLBI NIH HHS / United States N01 HC015103 / HC / NHLBI NIH HHS / United States HHSN268201100009C / / PHS HHS / United States HHSN268201100011I / HL / NHLBI NIH HHS / United States HHSN268201100011C / HL / NHLBI NIH HHS / United States R01-HL-087652 / HL / NHLBI NIH HHS / United States U01-HL-080295 / HL / NHLBI NIH HHS / United States R01 HL087652 / HL / NHLBI NIH HHS / United States N01HC55222 / HL / NHLBI NIH HHS / United States N01-HC-85086 / HC / NHLBI NIH HHS / United States HHSN268201100010C / / PHS HHS / United States N01HC85086 / HL / NHLBI NIH HHS / United States R01 HL088456 / HL / NHLBI NIH HHS / United States N01-HC-85082 / HC / NHLBI NIH HHS / United States HHSN268201100006C / HL / NHLBI NIH HHS / United States HHSN268201200036C / HL / NHLBI NIH HHS / United States HHSN268201100008C / / PHS HHS / United States HHSN268201100012C / / PHS HHS / United States HHSN268201100005I / HL / NHLBI NIH HHS / United States N01-HC-55222 / HC / NHLBI NIH HHS / United States N01-HC-85083 / HC / NHLBI NIH HHS / United States N01-HC-75150 / HC / NHLBI NIH HHS / United States N01-HC-85080 / HC / NHLBI NIH HHS / United States HHSN268201100007C / / PHS HHS / United States N01HC75150 / HL / NHLBI NIH HHS / United States R01-HL-088456 / HL / NHLBI NIH HHS / United States HHSN268201100009C / HL / NHLBI NIH HHS / United States HHSN268201100011C / / PHS HHS / United States HHSN268201100005C / HL / NHLBI NIH HHS / United States HHSN268201100007I / HL / NHLBI NIH HHS / United States N01-HC-85079 / HC / NHLBI NIH HHS / United States N01HC85079 / HL / NHLBI NIH HHS / United States HHSN268201100006C / / PHS HHS / United States N01 HC045133 / HC / NHLBI NIH HHS / United States N01 HC035129 / HC / NHLBI NIH HHS / United States N01-HC-85084 / HC / NHLBI NIH HHS / United States |