Journal
CLINICAL CARDIOLOGY
Volume 45, Issue 5, Pages 461-473Publisher
WILEY
DOI: 10.1002/clc.23804
Keywords
adverse cardiovascular events; early repolarization pattern; meta-analysis; vasospastic angina; ventricular fibrillation
Categories
Funding
- Key Research and Development Program of Shandong Province [2019GSF108142]
- Medical and Health Development Program of Shandong Province [202103010621]
- Science and Technology Program of Yantai City [2021MSGY042, 2021MSGY044]
- Youth Research Foundation of Yantai Yuhuangding Hospital [201901]
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This study investigated the relationship between early repolarization (ER) pattern and ventricular fibrillation (VF) in patients with vasospastic angina (VSA). The results showed that ER pattern significantly predicted adverse cardiovascular events and VF in VSA patients. The presence of ER in the inferior leads with horizontal/descending ST-segment elevation conferred the highest risk for VF during VSA onset. However, obstructive coronary artery disease was unrelated to the ER pattern.
Background An early repolarization (ER) pattern is a risk factor for ventricular fibrillation (VF) in patients with vasospastic angina (VSA) caused by a coronary artery spasm. However, its detailed characteristics and prognostic value for VF remain unclear. Thus, we investigated the relationship between ER and VF in patients with VSA. Hypothesis The ER pattern is associated with VF in patients with VSA. Methods In this systematic review and meta-analysis, we searched PubMed, Embase, Cochrane Library, and Web of Science databases for eligible studies published between January 2011 and December 2020; 8 studies with 1761 patients were included in the final analysis. Results The ER pattern significantly predicted adverse cardiovascular events (ACEs) and VF (odds ratio [OR] = 5.13, 95% confidence interval [95% CI]: 3.16-8.35, p < .00001 and OR = 5.20, 95% CI: 3.05-8.87, p < .00001). The presence of ER in the inferior leads increased the VF risk (OR = 7.80, 95% CI: 4.04-15.05, p < .00001), regardless of the J-point morphology or type of ST-segment elevation in the ER pattern. A horizontal/descending ST-segment elevation was significantly associated with VF in patients with or without an ER pattern during a coronary spasm (OR = 2.28, 95% CI: 1.07-4.88, p = .03). However, obstructive coronary artery disease was unrelated to the ER pattern (OR = 0.82, 95% CI: 0.27-2.53, p = .73). Conclusions An ER pattern is significantly associated with an increased risk of ACE in patients with VSA. An inferior ER pattern with horizontal/descending ST-segment elevation confers the highest risk for VF during VSA onset. Nevertheless, the ER pattern is not associated with obstructive coronary artery disease.
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