title: Electrocardiographic and clinical predictors separating atherosclerotic sudden cardiac death from incident coronary heart disease.
abstract: OBJECTIVE
  To identify specific ECG and clinical predictors that separate atherosclerotic sudden cardiac death (SCD) from incident coronary heart disease (CHD) (non-fatal events and non-sudden death) in the combined cohorts of the Atherosclerosis Risk in Communities study and the Cardiovascular Health Study.
  
  
  METHODS
  This analysis included 18,497 participants (58% females, 24% black individuals, mean age 58 years) who were initially free of clinical CHD. A competing risk analysis was conducted to examine the prognostic significance of baseline clinical characteristics and an extensive electronic database of ECG measurements for prediction of 229 cases of SCD as a first event versus 2297 incident CHD cases (2122 non-fatal events and 175 non-sudden death) that occurred during a median follow-up time of 13 years in the Cardiovascular Health Study and 14 years in the Atherosclerosis Risk in Communities study.
  
  
  RESULTS
  After adjusting for common CHD risk factors, a number of clinical characteristics and ECG measurements were independently predictive of SCD and CHD. However, the risk of SCD versus incident CHD was significantly different for race/ethnicity, hypertension, body mass index (BMI), heart rate, QTc, abnormally inverted T wave in any ECG lead group and level of ST elevation in V2. Black race/ethnicity (compared to non-black) was predictive of high SCD risk but less risk of incident CHD (p value for differences in the risk (HR) for SCD versus CHD <0.0001). Hypertension, increased heart rate, prolongation of QTc and abnormally inverted T wave were stronger predictors of high SCD risk compared to CHD (p value=0.0460, 0.0398, 0.0158 and 0.0265, respectively). BMI was not predictive of incident CHD but was predictive of high SCD risk in a quadratic fashion (p value=0.0220). On the other hand, elevated ST height as measured at the J point and that measured at 60 ms after the J point in V2 were not predictive of SCD but were predictive of high incident CHD risk (p value=0.0251 and 0.0155, respectively).
  
  
  CONCLUSIONS
  SCD and CHD have many risk factors in common. Hypertension, race/ethnicity, BMI, heart rate, QTc, abnormally inverted T wave in any ECG lead group and level of ST elevation in V2 have the potential to separate between the risks of SCD and CHD. These results need to be validated in another cohort.
authors.affiliation: Epidemiological Cardiology Center, Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1063, USA. esoliman@wfubmc.edu
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Prineas
authors.forename: L Douglas
authors.initials: LD
authors.lastname: Case
authors.forename: Gregory
authors.initials: G
authors.lastname: Russell
authors.forename: Wayne
authors.initials: W
authors.lastname: Rosamond
authors.forename: Thomas
authors.initials: T
authors.lastname: Rea
authors.forename: Nona
authors.initials: N
authors.lastname: Sotoodehnia
authors.forename: Wendy S
authors.initials: WS
authors.lastname: Post
authors.forename: David
authors.initials: D
authors.lastname: Siscovick
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Psaty
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Burke
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003327:Coronary Disease / Q000175:diagnosis* / Q000208:ethnology / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D004562:Electrocardiography; D005006:Ethnicity; D005260:Female; D006339:Heart Rate; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D044469:Racial Groups; D020379:Risk Adjustment; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology