Epidemiological Cardiology Center, Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1063, USA.
Heart. 2011 Oct;97(19):1597-601. doi: 10.1136/hrt.2010.215871. Epub 2011 Jul 20.
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.
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.
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).
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.
在社区动脉粥样硬化风险研究（Atherosclerosis Risk in Communities study，ARIC）和心血管健康研究（Cardiovascular Health Study，CHS）的合并队列中，确定能够区分动脉粥样硬化性心源性猝死（SCD）与冠心病（CHD）（非致命事件和非猝死）的特定心电图（ECG）和临床预测指标。
本分析纳入了 18497 名最初无临床 CHD 的参与者（58%为女性，24%为黑人，平均年龄 58 岁）。采用竞争风险分析，以研究基线临床特征和广泛的 ECG 测量电子数据库对预测 229 例 SCD 作为首发事件的预后意义，以及在 CHS 中位数随访 13 年和 ARIC 中位数随访 14 年期间发生的 2297 例 CHD 事件（2122 例非致命事件和 175 例非猝死）。
在调整常见 CHD 危险因素后，一些临床特征和 ECG 测量值可独立预测 SCD 和 CHD。然而，种族/民族、高血压、体重指数（BMI）、心率、QTc、任何 ECG 导联组的异常倒置 T 波以及 V2 中 ST 抬高水平对 SCD 与 CHD 风险的影响明显不同。与非黑人相比，黑人种族/民族（与非黑人相比）预测 SCD 风险较高，但 CHD 风险较低（SCD 与 CHD 风险差异的 HR 值的差异 p 值<0.0001）。与 CHD 相比，高血压、心率增加、QTc 延长和异常倒置 T 波更能预测 SCD 风险较高（p 值分别为 0.0460、0.0398、0.0158 和 0.0265）。BMI 不能预测 CHD 事件，但呈二次方形式预测 SCD 风险较高（p 值=0.0220）。另一方面，在 V2 中 J 点测量的 ST 抬高高度和 J 点后 60ms 测量的 ST 抬高高度不能预测 SCD，但能预测 CHD 事件风险较高（p 值分别为 0.0251 和 0.0155）。
SCD 和 CHD 有许多共同的危险因素。高血压、种族/民族、BMI、心率、QTc、任何 ECG 导联组的异常倒置 T 波以及 V2 中的 ST 抬高水平有可能区分 SCD 和 CHD 的风险。这些结果需要在另一个队列中进行验证。
