Electrocardiographic early repolarization is associated with future ventricular arrhythmia after acute myocardial infarction—Systematic Review and Meta‐Analysis
Background Early repolarization (ER) has been linked to ventricular arrhythmia (VA) and sudden cardiac death in patients without structural heart disease. We aimed to assess the latest evidence on whether ER is associated with future VA after acute myocardial infarction (AMI). Methods We performed a...
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| Published in | Journal of arrhythmia Vol. 35; no. 4; pp. 626 - 635 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Japan
John Wiley & Sons, Inc
01.08.2019
John Wiley and Sons Inc Wiley |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1880-4276 1883-2148 1883-2148 |
| DOI | 10.1002/joa3.12196 |
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| Abstract | Background
Early repolarization (ER) has been linked to ventricular arrhythmia (VA) and sudden cardiac death in patients without structural heart disease. We aimed to assess the latest evidence on whether ER is associated with future VA after acute myocardial infarction (AMI).
Methods
We performed a comprehensive search on the topic that assesses ER and VA/adverse cardiovascular events in AMI. We included studies with sufficient details on ER and VA, we also performed a meta‐analysis on their morphology.
Results
A total of 3350 subjects from 9 studies were included. Five hundred and twenty‐one (15.55%) had ER and 2829 (84.45%) did not. On meta‐analysis, ER (+) in AMI was associated with VA with a pooled odds ratio (OR) of 3.58 (2.70‐4.73), P < 0.001; heterogeneity I2 34%. Subgroup analysis of patients with ST‐segment elevation myocardial infarction (STEMI) showed an OR of 2.79 [1.98‐3.93], P < 0.001; heterogeneity I2 0%. Inferior location of ER (+) was associated with VA OR 3.98 [1.86‐8.53], P = 0.008; I2 67%. Notching had a 5.41 [3.52‐8.32], P < 0.001; low heterogeneity I2 0% of having VA. Pooled OR for J‐point elevation was 4.72 [2.63‐8.46], P < 0.001; I2 25%. Horizontal ST‐segment was associated with VA with an OR of 4.30 [1.89‐975], P < 0.001; I2 59%. Lateral location and slurred morphology were not associated with VA. Upon sensitivity analysis for inferior location and horizontal ST‐segment, removal of a study reduces heterogeneity significantly.
Conclusion
Early repolarization especially those with the inferior location, notching morphology, an elevated J‐point and horizontal ST‐segment had a higher likelihood of VA in AMI including STEMI patients. |
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| AbstractList | Early repolarization (ER) has been linked to ventricular arrhythmia (VA) and sudden cardiac death in patients without structural heart disease. We aimed to assess the latest evidence on whether ER is associated with future VA after acute myocardial infarction (AMI).
We performed a comprehensive search on the topic that assesses ER and VA/adverse cardiovascular events in AMI. We included studies with sufficient details on ER and VA, we also performed a meta-analysis on their morphology.
A total of 3350 subjects from 9 studies were included. Five hundred and twenty-one (15.55%) had ER and 2829 (84.45%) did not. On meta-analysis, ER (+) in AMI was associated with VA with a pooled odds ratio (OR) of 3.58 (2.70-4.73),
< 0.001; heterogeneity
34%. Subgroup analysis of patients with ST-segment elevation myocardial infarction (STEMI) showed an OR of 2.79 [1.98-3.93],
< 0.001; heterogeneity
0%. Inferior location of ER (+) was associated with VA OR 3.98 [1.86-8.53],
= 0.008;
67%. Notching had a 5.41 [3.52-8.32],
< 0.001; low heterogeneity
0% of having VA. Pooled OR for J-point elevation was 4.72 [2.63-8.46],
< 0.001;
25%. Horizontal ST-segment was associated with VA with an OR of 4.30 [1.89-975],
< 0.001;
59%. Lateral location and slurred morphology were not associated with VA. Upon sensitivity analysis for inferior location and horizontal ST-segment, removal of a study reduces heterogeneity significantly.
Early repolarization especially those with the inferior location, notching morphology, an elevated J-point and horizontal ST-segment had a higher likelihood of VA in AMI including STEMI patients. Abstract Background Early repolarization (ER) has been linked to ventricular arrhythmia (VA) and sudden cardiac death in patients without structural heart disease. We aimed to assess the latest evidence on whether ER is associated with future VA after acute myocardial infarction (AMI). Methods We performed a comprehensive search on the topic that assesses ER and VA/adverse cardiovascular events in AMI. We included studies with sufficient details on ER and VA, we also performed a meta‐analysis on their morphology. Results A total of 3350 subjects from 9 studies were included. Five hundred and twenty‐one (15.55%) had ER and 2829 (84.45%) did not. On meta‐analysis, ER (+) in AMI was associated with VA with a pooled odds ratio (OR) of 3.58 (2.70‐4.73), P < 0.001; heterogeneity I2 34%. Subgroup analysis of patients with ST‐segment elevation myocardial infarction (STEMI) showed an OR of 2.79 [1.98‐3.93], P < 0.001; heterogeneity I2 0%. Inferior location of ER (+) was associated with VA OR 3.98 [1.86‐8.53], P = 0.008; I2 67%. Notching had a 5.41 [3.52‐8.32], P < 0.001; low heterogeneity I2 0% of having VA. Pooled OR for J‐point elevation was 4.72 [2.63‐8.46], P < 0.001; I2 25%. Horizontal ST‐segment was associated with VA with an OR of 4.30 [1.89‐975], P < 0.001; I2 59%. Lateral location and slurred morphology were not associated with VA. Upon sensitivity analysis for inferior location and horizontal ST‐segment, removal of a study reduces heterogeneity significantly. Conclusion Early repolarization especially those with the inferior location, notching morphology, an elevated J‐point and horizontal ST‐segment had a higher likelihood of VA in AMI including STEMI patients. Background: Early repolarization (ER) has been linked to ventricular arrhythmia (VA) and sudden cardiac death in patients without structural heart disease. We aimed to assess the latest evidence on whether ER is associated with future VA after acute myocardial infarction (AMI). Methods: We performed a comprehensive search on the topic that assesses ER and VA/adverse cardiovascular events in AMI. We included studies with sufficient details on ER and VA, we also performed a meta-analysis on their morphology. Results: A total of 3350 subjects from 9 studies were included. Five hundred and twenty-one (15.55%) had ER and 2829 (84.45%) did not. On meta-analysis, ER (+) in AMI was associated with VA with a pooled odds ratio (OR) of 3.58 (2.70-4.73), P < 0.001; heterogeneity I[sup.2] 34%. Subgroup analysis of patients with ST-segment elevation myocardial infarction (STEMI) showed an OR of 2.79 [1.98-3.93], P < 0.001; heterogeneity I[sup.2] 0%. Inferior location of ER (+) was associated with VA OR 3.98 [1.86-8.53], P = 0.008; I[sup.2] 67%. Notching had a 5.41 [3.52-8.32], P < 0.001; low heterogeneity I[sup.2] 0% of having VA. Pooled OR for J-point elevation was 4.72 [2.63-8.46], P < 0.001; I[sup.2] 25%. Horizontal ST-segment was associated with VA with an OR of 4.30 [1.89-975], P < 0.001; I[sup.2] 59%. Lateral location and slurred morphology were not associated with VA. Upon sensitivity analysis for inferior location and horizontal ST-segment, removal of a study reduces heterogeneity significantly. Conclusion: Early repolarization especially those with the inferior location, notching morphology, an elevated J-point and horizontal ST-segment had a higher likelihood of VA in AMI including STEMI patients. Early repolarization (ER) has been linked to ventricular arrhythmia (VA) and sudden cardiac death in patients without structural heart disease. We aimed to assess the latest evidence on whether ER is associated with future VA after acute myocardial infarction (AMI). We performed a comprehensive search on the topic that assesses ER and VA/adverse cardiovascular events in AMI. We included studies with sufficient details on ER and VA, we also performed a meta-analysis on their morphology. A total of 3350 subjects from 9 studies were included. Five hundred and twenty-one (15.55%) had ER and 2829 (84.45%) did not. On meta-analysis, ER (+) in AMI was associated with VA with a pooled odds ratio (OR) of 3.58 (2.70-4.73), P < 0.001; heterogeneity I[sup.2] 34%. Subgroup analysis of patients with ST-segment elevation myocardial infarction (STEMI) showed an OR of 2.79 [1.98-3.93], P < 0.001; heterogeneity I[sup.2] 0%. Inferior location of ER (+) was associated with VA OR 3.98 [1.86-8.53], P = 0.008; I[sup.2] 67%. Notching had a 5.41 [3.52-8.32], P < 0.001; low heterogeneity I[sup.2] 0% of having VA. Pooled OR for J-point elevation was 4.72 [2.63-8.46], P < 0.001; I[sup.2] 25%. Horizontal ST-segment was associated with VA with an OR of 4.30 [1.89-975], P < 0.001; I[sup.2] 59%. Lateral location and slurred morphology were not associated with VA. Upon sensitivity analysis for inferior location and horizontal ST-segment, removal of a study reduces heterogeneity significantly. Early repolarization especially those with the inferior location, notching morphology, an elevated J-point and horizontal ST-segment had a higher likelihood of VA in AMI including STEMI patients. Early repolarization (ER) has been linked to ventricular arrhythmia (VA) and sudden cardiac death in patients without structural heart disease. We aimed to assess the latest evidence on whether ER is associated with future VA after acute myocardial infarction (AMI).BACKGROUNDEarly repolarization (ER) has been linked to ventricular arrhythmia (VA) and sudden cardiac death in patients without structural heart disease. We aimed to assess the latest evidence on whether ER is associated with future VA after acute myocardial infarction (AMI).We performed a comprehensive search on the topic that assesses ER and VA/adverse cardiovascular events in AMI. We included studies with sufficient details on ER and VA, we also performed a meta-analysis on their morphology.METHODSWe performed a comprehensive search on the topic that assesses ER and VA/adverse cardiovascular events in AMI. We included studies with sufficient details on ER and VA, we also performed a meta-analysis on their morphology.A total of 3350 subjects from 9 studies were included. Five hundred and twenty-one (15.55%) had ER and 2829 (84.45%) did not. On meta-analysis, ER (+) in AMI was associated with VA with a pooled odds ratio (OR) of 3.58 (2.70-4.73), P < 0.001; heterogeneity I 2 34%. Subgroup analysis of patients with ST-segment elevation myocardial infarction (STEMI) showed an OR of 2.79 [1.98-3.93], P < 0.001; heterogeneity I 2 0%. Inferior location of ER (+) was associated with VA OR 3.98 [1.86-8.53], P = 0.008; I 2 67%. Notching had a 5.41 [3.52-8.32], P < 0.001; low heterogeneity I 2 0% of having VA. Pooled OR for J-point elevation was 4.72 [2.63-8.46], P < 0.001; I 2 25%. Horizontal ST-segment was associated with VA with an OR of 4.30 [1.89-975], P < 0.001; I 2 59%. Lateral location and slurred morphology were not associated with VA. Upon sensitivity analysis for inferior location and horizontal ST-segment, removal of a study reduces heterogeneity significantly.RESULTSA total of 3350 subjects from 9 studies were included. Five hundred and twenty-one (15.55%) had ER and 2829 (84.45%) did not. On meta-analysis, ER (+) in AMI was associated with VA with a pooled odds ratio (OR) of 3.58 (2.70-4.73), P < 0.001; heterogeneity I 2 34%. Subgroup analysis of patients with ST-segment elevation myocardial infarction (STEMI) showed an OR of 2.79 [1.98-3.93], P < 0.001; heterogeneity I 2 0%. Inferior location of ER (+) was associated with VA OR 3.98 [1.86-8.53], P = 0.008; I 2 67%. Notching had a 5.41 [3.52-8.32], P < 0.001; low heterogeneity I 2 0% of having VA. Pooled OR for J-point elevation was 4.72 [2.63-8.46], P < 0.001; I 2 25%. Horizontal ST-segment was associated with VA with an OR of 4.30 [1.89-975], P < 0.001; I 2 59%. Lateral location and slurred morphology were not associated with VA. Upon sensitivity analysis for inferior location and horizontal ST-segment, removal of a study reduces heterogeneity significantly.Early repolarization especially those with the inferior location, notching morphology, an elevated J-point and horizontal ST-segment had a higher likelihood of VA in AMI including STEMI patients.CONCLUSIONEarly repolarization especially those with the inferior location, notching morphology, an elevated J-point and horizontal ST-segment had a higher likelihood of VA in AMI including STEMI patients. Background Early repolarization (ER) has been linked to ventricular arrhythmia (VA) and sudden cardiac death in patients without structural heart disease. We aimed to assess the latest evidence on whether ER is associated with future VA after acute myocardial infarction (AMI). Methods We performed a comprehensive search on the topic that assesses ER and VA/adverse cardiovascular events in AMI. We included studies with sufficient details on ER and VA, we also performed a meta‐analysis on their morphology. Results A total of 3350 subjects from 9 studies were included. Five hundred and twenty‐one (15.55%) had ER and 2829 (84.45%) did not. On meta‐analysis, ER (+) in AMI was associated with VA with a pooled odds ratio (OR) of 3.58 (2.70‐4.73), P < 0.001; heterogeneity I2 34%. Subgroup analysis of patients with ST‐segment elevation myocardial infarction (STEMI) showed an OR of 2.79 [1.98‐3.93], P < 0.001; heterogeneity I2 0%. Inferior location of ER (+) was associated with VA OR 3.98 [1.86‐8.53], P = 0.008; I2 67%. Notching had a 5.41 [3.52‐8.32], P < 0.001; low heterogeneity I2 0% of having VA. Pooled OR for J‐point elevation was 4.72 [2.63‐8.46], P < 0.001; I2 25%. Horizontal ST‐segment was associated with VA with an OR of 4.30 [1.89‐975], P < 0.001; I2 59%. Lateral location and slurred morphology were not associated with VA. Upon sensitivity analysis for inferior location and horizontal ST‐segment, removal of a study reduces heterogeneity significantly. Conclusion Early repolarization especially those with the inferior location, notching morphology, an elevated J‐point and horizontal ST‐segment had a higher likelihood of VA in AMI including STEMI patients. |
| Audience | Academic |
| Author | Pranata, Raymond Raharjo, Sunu Budhi Yonas, Emir Vania, Rachel Siswanto, Bambang Budi Setianto, Budhi |
| AuthorAffiliation | 1 Faculty of Medicine Universitas Pelita Harapan Tangerang Indonesia 2 Faculty of Medicine Universitas YARSI Jakarta Indonesia 3 Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia National Cardiovascular Center Harapan Kita Jakarta Indonesia |
| AuthorAffiliation_xml | – name: 3 Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia National Cardiovascular Center Harapan Kita Jakarta Indonesia – name: 1 Faculty of Medicine Universitas Pelita Harapan Tangerang Indonesia – name: 2 Faculty of Medicine Universitas YARSI Jakarta Indonesia |
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| Keywords | ventricular arrhythmia acute myocardial infarction ST‐segment elevation myocardial infarction early repolarization |
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Early repolarization (ER) has been linked to ventricular arrhythmia (VA) and sudden cardiac death in patients without structural heart disease. We... Early repolarization (ER) has been linked to ventricular arrhythmia (VA) and sudden cardiac death in patients without structural heart disease. We aimed to... Background: Early repolarization (ER) has been linked to ventricular arrhythmia (VA) and sudden cardiac death in patients without structural heart disease. We... Abstract Background Early repolarization (ER) has been linked to ventricular arrhythmia (VA) and sudden cardiac death in patients without structural heart... |
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| SubjectTerms | acute myocardial infarction Arrhythmia Cardiac patients early repolarization Electrocardiogram Electrocardiography Heart Heart attack Medical research Medicine, Experimental Original ST‐segment elevation myocardial infarction ventricular arrhythmia |
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| Title | Electrocardiographic early repolarization is associated with future ventricular arrhythmia after acute myocardial infarction—Systematic Review and Meta‐Analysis |
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