title: Early repolarization and myocardial scar predict poorest prognosis in patients with coronary artery disease.
abstract: OBJECTIVE
  Recent studies show positive association of early repolarization (ER) with the risk of life-threatening arrhythmias in patients with coronary artery disease (CAD). This study was to investigate the relationships of ER with myocardial scarring and prognosis in patients with CAD.
  
  
  METHODS
  Of 570 consecutive CAD patients, patients with and without ER were assigned to ER group (n=139) and no ER group (n=431), respectively. Myocardial scar was evaluated using cardiac single-photon emission computed tomography.
  
  
  RESULTS
  ER group had previous history of myocardial infarction (33% vs. 15%, p<0.001) and lower left ventricular ejection fraction (57±13% vs. 62±13%, p<0.001) more frequently than no-ER group. While 74 (53%) patients in ER group had myocardial scar, only 121 (28%) patients had in no-ER group (p<0.001). During follow up, 9 (7%) and 4 (0.9%) patients had cardiac events in ER and no-ER group, respectively (p=0.001). All patients with cardiac events had ER in inferior leads and horizontal/descending ST-segment. Patients with both ER in inferior leads and horizontal/descending ST variant and scar had an increased adjusted hazard ratio of cardiac events (hazard ratio 16.0; 95% confidence interval: 4.1 to 55.8; p<0.001).
  
  
  CONCLUSIONS
  ER in inferior leads with a horizontal/descending ST variant was associated with increased risk of cardiac events. These findings suggest that ER in patients with CAD may be related to myocardial scar rather than pure ion channel problem.
authors: Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. ; Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
authors: Hye-Young
authors: HY
authors: Lee
authors: Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors: Hee-Sun
authors: HS
authors: Mun
authors: Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors: Jin
authors: J
authors: Wi
authors: Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors: Jae-Sun
authors: JS
authors: Uhm
authors: Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors: Jaemin
authors: J
authors: Shim
authors: Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors: Jong-Youn
authors: JY
authors: Kim
authors: Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors: Hui-Nam
authors: HN
authors: Pak
authors: Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors: Moon-Hyoung
authors: MH
authors: Lee
authors: Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea. cby6908@yuhs.ac.
authors: Boyoung
authors: B
authors: Joung
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000503:physiopathology; D053840:Brugada Syndrome; D000075224:Cardiac Conduction System Disease; D002921:Cicatrix / Q000503:physiopathology*; D003324:Coronary Artery Disease / Q000473:pathology* / Q000503:physiopathology*; D016757:Death, Sudden, Cardiac / Q000473:pathology; D005260:Female; D006329:Heart Conduction System / Q000002:abnormalities / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D011379:Prognosis
keywords: Electrocardiography; cardiac arrhythmia; coronary artery disease; sudden cardiac death