The prognostic value of early repolarization with ST elevation in African Americans.
Heart Rhythm. 2011 Nov 14;
Authors: Perez MV, Uberoi A, Jain NA, Ashley E, Turakhia MP, Froelicher V
BACKGROUND: Increased prevalence of classic early repolarization, defined as ST elevation (STE) in the absence of acute myocardial injury, in African Americans is well established. The prognostic value of this pattern in different ethnicities remains controversial. OBJECTIVE: Measure association between early repolarization and cardiovascular mortality in African Americans. METHODS: The resting ECGs of 45,829 patients were evaluated at the Palo Alto Veterans Hospital. Subjects with inpatient status or ECG-evidence of acute myocardial infarction were excluded, leaving 29,281 subjects. ST elevation, defined as elevation of >0.1mV at the end of the QRS, was electronically flagged and visually adjudicated by three observers blinded to outcomes. Association between ethnicity and early repolarization was measured using multivariate logistic regression. We analyzed associations between early repolarization and cardiovascular mortality using Cox hazard regression. RESULTS: Subjects were 13% female and 13.3% African American, with an average age of 55 years and followed for an average of 7.6 years, resulting in 1995 cardiac deaths. There were 479 subjects with lateral STE and 185 with inferior STE. After adjustment for age, gender, heart rate and coronary disease, African-American ethnicity was associated with lateral or inferior STE (OR 3.1, p=0.0001). While lateral or inferior STE in non-African Americans was independently associated with cardiovascular death (HR 1.6, p=0.02), it was not associated with cardiovascular death in African Americans (HR 0.75, p=0.50). CONCLUSIONS: Although early repolarization is more prevalent in African Americans, it is not predictive of cardiovascular death in this population and may represent a distinct electrophysiologic phenomenon.
PMID: 22094072 [PubMed - as supplied by publisher]