title: The prognostic value of early repolarization with ST-segment elevation in African Americans.
abstract: BACKGROUND
  Increased prevalence of classic early repolarization, defined as ST-segment elevation (STE) in the absence of acute myocardial injury, in African Americans is well established. The prognostic value of this pattern in different ethnicities remains controversial.
  
  
  OBJECTIVE
  Measure association between early repolarization and cardiovascular mortality in African Americans.
  
  
  METHODS
  The resting electrocardiograms of 45,829 patients were evaluated at the Palo Alto Veterans Affairs Hospital. Subjects with inpatient status or electrocardiographic evidence of acute myocardial infarction were excluded, leaving 29,281 subjects. ST-segment elevation, defined as an elevation of >0.1 mV at the end of the QRS, was electronically flagged and visually adjudicated by 3 observers blinded to outcomes. An association between ethnicity and early repolarization was measured by using multivariate logistic regression. We analyzed associations between early repolarization and cardiovascular mortality by using the Cox proportional hazards regression analysis.
  
  
  RESULTS
  Subjects were 13% women and 13.3% African Americans, with an average age of 55 years and followed for an average of 7.6 years, resulting in 1995 cardiovascular deaths. There were 479 subjects with lateral STE and 185 with inferior STE. After adjustment for age, sex, heart rate, and coronary artery disease, African American ethnicity was associated with lateral or inferior STE (odds ratio 3.1; P = .0001). While lateral or inferior STE in non-African Americans was independently associated with cardiovascular death (hazard ratio 1.6; P = .02), it was not associated with cardiovascular death in African Americans (hazard ratio 0.75; P = .50).
  
  
  CONCLUSIONS
  Although early repolarization is more prevalent in African Americans, it is not predictive of cardiovascular death in this population and may represent a distinct electrophysiologic phenomenon.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California 94305-5233, USA. mvperez@stanford.edu
authors.forename: Marco V
authors.initials: MV
authors.lastname: Perez
authors.forename: Abhimanyu
authors.initials: A
authors.lastname: Uberoi
authors.forename: Nikhil A
authors.initials: NA
authors.lastname: Jain
authors.forename: Euan
authors.initials: E
authors.lastname: Ashley
authors.forename: Mintu P
authors.initials: MP
authors.lastname: Turakhia
authors.forename: Victor
authors.initials: V
authors.lastname: Froelicher
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality; D005260:Female; D017144:Focus Groups; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality; D016017:Odds Ratio; D011379:Prognosis; D013223:Statistics as Topic; D013997:Time Factors; D014481:United States / Q000453:epidemiology