Association of Early Repolarization Pattern on ECG with Risk of Cardiac and All-Cause Mortality: A Population-Based Prospective Cohort Study (MONICA/KORA)
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BACKGROUND: Early repolarization pattern (ERP) on electrocardiogram was associated with idiopathic ventricular fibrillation and sudden cardiac arrest in a case-control study and with cardiovascular mortality in a Finnish community-based sample. We sought to determine ERP prevalence and its association with cardiac and all-cause mortality in a large, prospective, population-based case-cohort study (Monitoring of Cardiovascular Diseases and Conditions [MONICA]/KORA [Cooperative Health Research in the Region of Augsburg]) comprised of individuals of Central-European descent. METHODS AND FINDINGS: Electrocardiograms of 1,945 participants aged 35-74 y, representing a source population of 6,213 individuals, were analyzed applying a case-cohort design. Mean follow-up was 18.9 y. Cause of death was ascertained by the 9th revision of the International Classification of Disease (ICD-9) codes as documented in death certificates. ERP-attributable effects on mortality were determined by a weighted Cox proportional hazard model adjusted for covariables. Prevalence of ERP was 13.1% in our study. ERP was associated with cardiac and all-cause mortality, most pronounced in those of younger age and male sex; a clear ERP-age interaction was detected (p = 0.005). Age-stratified analyses showed hazard ratios (HRs) for cardiac mortality of 1.96 (95% confidence interval [CI] 1.05-3.68, p = 0.035) for both sexes and 2.65 (95% CI 1.21-5.83, p = 0.015) for men between 35-54 y. An inferior localization of ERP further increased ERP-attributable cardiac mortality to HRs of 3.15 (95% CI 1.58-6.28, p = 0.001) for both sexes and to 4.27 (95% CI 1.90-9.61, p<0.001) for men between 35-54 y. HRs for all-cause mortality were weaker but reached significance. CONCLUSIONS: We found a high prevalence of ERP in our population-based cohort of middle-aged individuals. ERP was associated with about a 2- to 4-fold increased risk of cardiac mortality in individuals between 35 and 54 y. An inferior localization of ERP was associated with a particularly increased risk. Please see later in the article for the Editors' Summary.
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Early repolarization pattern is associated with increased risk of cardiac death in population-based studies.
“Furthermore, it has been shown in population-based studies to be associated with increased risk of cardiac death (352,353,355–357).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [357]
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- Authors
- Sinner, M. F., Reinhard, W., Müller, M., Beckmann, B.-M., Martens, E., Perz, S., Pfeufer, A., Winogradow, J., Stark, K., Meisinger, C., Wichmann, H.-E., Peters, A., Riegger, G. A. J., Steinbeck, G., Hengstenberg, C., & Kääb, S.
- Affiliations
- Ludwig-Maximilians-Universität München (DE)
- University Hospital Regensburg (DE)
- Helmholtz Munich (DE)
- Corresponding author
- Kääb, Stefan
- ORCID
- Venue
- PLoS Medicine
- Publisher
- Public Library of Science (PLoS)
- Published
- 2010-07-27
- Volume
- 7
- Issue
- 7
- Pages
- e1000314
- ISSN
- 1549-1277 (ISSN-L)
- 1549-1676
- PMC
- PMC2910598
- OpenAlex
- W2133142369
- Cited by
- 282
- References
- 35
- Citations by year
- 2026: 7 · 2025: 6 · 2024: 4 · 2023: 7 · 2022: 12 · 2021: 6 · 2020: 11 · 2019: 18 · 2018: 14 · 2017: 25 · 2016: 32 · 2015: 26 · 2014: 19 · 2013: 39 · 2012: 24
- FWCI
- 20.87
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Open access LMU (Ludwid Maxmilian's Universitat Munchen) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- mediaTUM (Technical University of Munich) (submittedVersion)
- Site cant be reached (submittedVersion, cc-by)
- OPUS (Augsburg University) (submittedVersion, cc-by)
- Funders
- Deutsche Forschungsgemeinschaft
- Fondation Leducq (01GS0838)
- Bundesministerium für Bildung und Forschung (01GS0499, 01GS0838)
- Münchner Zentrum für Gesundheitswissenschaften
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- early repolarization, electrocardiogram, cardiac mortality, all-cause mortality, sudden cardiac death, age-stratified risk, sex differences, middle-aged adults, cardiovascular risk factors, Central European population, idiopathic ventricular fibrillation, sudden cardiac arrest, cardiovascular disease monitoring, cardiovascular disease prevention, cardiovascular disease treatment
- MeSH terms
- Adult, Aged, Cause of Death, Electrocardiography, Female, Germany, Heart Diseases, Humans, Male, Middle Aged, Population, Population Surveillance, Prospective Studies, Risk, Time Factors, Cohort Studies, Case-Control Studies
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