title: Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men: a population-based follow-up study.
abstract: OBJECTIVE
  Silent electrocardiographic ST change predicts future coronary events in patients with coronary heart disease (CHD), but the prognostic significance of asymptomatic ST-segment depression with respect to sudden cardiac death in subjects without apparent CHD is not well known.
  
  
  RESULTS
  We investigated the association between silent ST-segment depression during and after maximal symptom-limited exercise test and the risk of sudden cardiac death in a population-based sample of 1769 men without evident CHD. A total of 72 sudden cardiac death occurred during the median follow-up of 18 years. The risk of sudden cardiac death was increased among men with asymptomatic ST-segment depression during exercise [hazard ratio (HR) 2.1, 95% confidence interval (CI) 1.2-3.9] as well as among those with asymptomatic ST-segment depression during recovery period (HR 3.2, 95% CI 1.7-6.0). Asymptomatic ST-depression during exercise testing was a stronger predictor for the risk of sudden cardiac death especially among smokers as well as in hypercholesterolaemic and hypertensive men than in men without these risk factors.
  
  
  CONCLUSIONS
  Asymptomatic ST-segment depression was a very strong predictor of sudden cardiac death in men with any conventional risk factor but no previously diagnosed CHD, emphasizing the value of exercise testing to identify asymptomatic high-risk men who could benefit from preventive measures.
authors.affiliation: Research Institute of Public Health, University of Kuopio, Kuopio, Finland. jariantero.laukkanen@uku.fi
authors.forename: Jari A
authors.initials: JA
authors.lastname: Laukkanen
authors.forename: Timo H
authors.initials: TH
authors.lastname: Mäkikallio
authors.forename: Rainer
authors.initials: R
authors.lastname: Rauramaa
authors.forename: Sudhir
authors.initials: S
authors.lastname: Kurl
mesh_terms: D000328:Adult; D015992:Body Mass Index; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology; D004562:Electrocardiography; D004812:Epidemiologic Methods; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test / Q000379:methods; D005387:Finland / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology