Pranata Raymond, Yonas Emir, Vania Rachel, Raharjo Sunu Budhi, Siswanto Bambang Budi, Setianto Budhi
Faculty of Medicine Universitas Pelita Harapan Tangerang Indonesia.
Faculty of Medicine Universitas YARSI Jakarta Indonesia.
J Arrhythm. 2019 May 28;35(4):626-635. doi: 10.1002/joa3.12196. eCollection 2019 Aug.
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.
早期复极（ER）与无结构性心脏病患者的室性心律失常（VA）及心源性猝死有关。我们旨在评估关于ER是否与急性心肌梗死（AMI）后未来发生VA相关的最新证据。
我们对评估AMI中ER与VA/不良心血管事件的主题进行了全面检索。我们纳入了有关ER和VA有足够详细信息的研究，还对它们的形态进行了荟萃分析。
共纳入9项研究中的3350名受试者。521名（15.55%）有ER，2829名（84.45%）没有。荟萃分析显示，AMI中的ER（+）与VA相关，合并比值比（OR）为3.58（2.70 - 4.73），P < 0.001；异质性为34%。ST段抬高型心肌梗死（STEMI）患者的亚组分析显示OR为2.79 [1.98 - 3.93]，P < 0.001；异质性为0%。ER（+）位于下壁与VA相关，OR为3.98 [1.86 - 8.53]，P = 0.008；异质性为67%。有切迹与发生VA的OR为5.41 [3.52 - 8.32]，P < 0.001；低异质性为0%。J点抬高的合并OR为4.72 [2.63 - 8.46]，P < 0.001；异质性为25%。水平ST段与VA相关，OR为4.30 [1.89 - 9.75]，P < 0.001；异质性为59%。侧壁位置和模糊形态与VA无关。在下壁位置和水平ST段的敏感性分析中，去除一项研究可显著降低异质性。
早期复极，尤其是那些位于下壁、有切迹形态、J点抬高和水平ST段的早期复极，在包括STEMI患者在内的AMI患者中发生VA的可能性更高。
