Mei Wei-Yi, Liu Li-Juan, Xu Qing, Zheng Dong-Dan, Cheng Yun-Jiu
Department of Cardiology, the Eastern Hospital of the First Affiliated Hospital, Sun Yat-Sen University.
Int Heart J. 2019 Mar 20;60(2):296-302. doi: 10.1536/ihj.18-416. Epub 2019 Feb 22.
Recent reports show that an early repolarization pattern (ERP) is associated with a higher incidence of sudden cardiac death in patients with obstructive coronary artery disease (CAD). Sporadic case studies have pointed out that ERP might be related to obstructive CAD.In consecutive patients who had undergone coronary angiography, we investigated the relationship between ERP and obstructive CAD by evaluating its association with coronary artery stenosis.The study population consisted of 3785 patients (59.9% men; mean age 63.1 years) with or without obstructive CAD. Adjusting for major cardiovascular risk factors, ERP was significantly associated with obstructive CAD (adjusted odds ratio (OR): 2.24 [95% CI 1.70-2.95]) with an incremental predictive value (ROC AUC 0.76 versus 0.71, P = 0.02; NRI 55.3%, P < 0.001; IDI = 0.05, P = 0.008), specifically in subjects with low risk and intermediate risk. ERP also significantly improved the predictive value for multi-vessel disease (AUC: 0.77 versus 0.72, P = 0.02 for two-vessel disease; 0.79 versus 0.73, P = 0.04 for three-vessel disease). ERP was consistently associated with stenoses of 3 main coronary arteries.ERP is associated with significant increased risk for obstructive CAD.Further studies are warranted to confirm our results and to elucidate the specific pathogenic mechanisms.
近期报告显示，早期复极模式（ERP）与阻塞性冠状动脉疾病（CAD）患者心脏性猝死的较高发生率相关。零星的病例研究指出，ERP可能与阻塞性CAD有关。在连续接受冠状动脉造影的患者中，我们通过评估ERP与冠状动脉狭窄的关联，研究了ERP与阻塞性CAD之间的关系。研究人群包括3785例有或无阻塞性CAD的患者（男性占59.9%；平均年龄63.1岁）。在调整主要心血管危险因素后，ERP与阻塞性CAD显著相关（调整后的优势比（OR）：2.24 [95%置信区间1.70 - 2.95]），具有增量预测价值（ROC曲线下面积为0.76对0.71，P = 0.02；净重新分类改善率为55.3%，P < 0.001；综合判别改善率 = 0.05，P = 0.008），特别是在低风险和中等风险的受试者中。ERP还显著提高了对多支血管病变的预测价值（曲线下面积：两支血管病变为0.77对0.72，P = 0.02；三支血管病变为0.79对0.73，P = 0.04）。ERP与三支主要冠状动脉的狭窄始终相关。ERP与阻塞性CAD的风险显著增加相关。有必要进一步研究以证实我们的结果并阐明具体的致病机制。
