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Early repolarization and myocardial scar predict poorest prognosis in patients with coronary artery disease.

 Hye-Young Lee  ;  Hee-Sun Mun  ;  Jin Wi  ;  Jae-Sun Uhm  ;  Jaemin Shim  ;  Jong-Youn Kim  ;  Hui-Nam Pak  ;  Moon-Hyoung Lee  ;  Boyoung Joung 
 YONSEI MEDICAL JOURNAL, Vol.55(4) : 928-936, 2014 
Journal Title
Issue Date
Aged ; Arrhythmias, Cardiac/physiopathology ; Brugada Syndrome ; Cardiac Conduction System Disease ; Cicatrix/physiopathology* ; Coronary Artery Disease/pathology* ; Coronary Artery Disease/physiopathology* ; Death, Sudden, Cardiac/pathology ; Female ; Heart Conduction System/abnormalities ; Heart Conduction System/physiopathology ; Humans ; Male ; Middle Aged ; Myocardium/pathology* ; Prognosis
Electrocardiography ; cardiac arrhythmia ; coronary artery disease ; sudden cardiac death
PURPOSE: Recent studies show positive association of early repolarization (ER) with the risk of life-threatening arrhythmias in patients with coronary artery disease (CAD). This study was to investigate the relationships of ER with myocardial scarring and prognosis in patients with CAD. MATERIALS AND METHODS: Of 570 consecutive CAD patients, patients with and without ER were assigned to ER group (n=139) and no ER group (n=431), respectively. Myocardial scar was evaluated using cardiac single-photon emission computed tomography. RESULTS: ER group had previous history of myocardial infarction (33% vs. 15%, p<0.001) and lower left ventricular ejection fraction (57±13% vs. 62±13%, p<0.001) more frequently than no-ER group. While 74 (53%) patients in ER group had myocardial scar, only 121 (28%) patients had in no-ER group (p<0.001). During follow up, 9 (7%) and 4 (0.9%) patients had cardiac events in ER and no-ER group, respectively (p=0.001). All patients with cardiac events had ER in inferior leads and horizontal/descending ST-segment. Patients with both ER in inferior leads and horizontal/descending ST variant and scar had an increased adjusted hazard ratio of cardiac events (hazard ratio 16.0; 95% confidence interval: 4.1 to 55.8; p<0.001). CONCLUSION: ER in inferior leads with a horizontal/descending ST variant was associated with increased risk of cardiac events. These findings suggest that ER in patients with CAD may be related to myocardial scar rather than pure ion channel problem.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jong Youn(김종윤) ORCID logo https://orcid.org/0000-0001-7040-8771
Mun, Hee Sun(문희선)
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Shim, Jae Min(심재민)
Uhm, Jae Sun(엄재선) ORCID logo https://orcid.org/0000-0002-1611-8172
Wi, Jin(위진) ORCID logo https://orcid.org/0000-0003-0655-5130
Lee, Moon-Hyoung(이문형) ORCID logo https://orcid.org/0000-0002-7268-0741
Lee, Hye Young(이혜영)
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
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