Simple electrocardiographic measures improve sudden arrhythmic death prediction in coronary disease

Abstract

Aims To determine whether the combination of standard electrocardiographic (ECG) markers reflecting domains of arrhythmic risk improves sudden and/or arrhythmic death (SAD) risk stratification in patients with coronary heart disease (CHD). Methods and results The association between ECG markers and SAD was examined in a derivation cohort (PREDETERMINE; N = 5462) with adjustment for clinical risk factors, left ventricular ejection fraction (LVEF), and competing risk. Competing outcome models assessed the differential association of ECG markers with SAD and competing mortality. The predictive value of a derived ECG score was then validated (ARTEMIS; N = 1900). In the derivation cohort, the 5-year cumulative incidence of SAD was 1.5% [95% confidence interval (CI) 1.1–1.9] and 6.2% (95% CI 4.5–8.3) in those with a low- and high-risk ECG score, respectively (P for Δ < 0.001). A high-risk ECG score was more strongly associated with SAD than non-SAD mortality (adjusted hazard ratios = 2.87 vs. 1.38 respectively; P for Δ = 0.003) and the proportion of deaths due to SAD was greater in the high vs. low risk groups (24.9% vs. 16.5%, P for Δ = 0.03). Similar findings were observed in the validation cohort. The addition of ECG markers to a clinical risk factor model inclusive of LVEF improved indices of discrimination and reclassification in both derivation and validation cohorts, including correct reclassification of 28% of patients in the validation cohort [net reclassification improvement 28 (7–49%), P = 0.009]. Conclusion For patients with CHD, an externally validated ECG score enriched for both absolute and proportional SAD risk and significantly improved risk stratification compared to standard clinical risk factors including LVEF. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT01114269. ClinicalTrials.gov ID NCT01114269.

ECG Scoring for the Evaluation of Therapy-Naïve Cancer Patients to Predict Cardiotoxicity

“…The ECG score was calculated in all 134 patients [ 19 ] and 25 patients achieved 0 points, 67 patients achieved 1 point, 33 patients achieved 2 points, seven patients achieved 4 points and one achieved 4 or 5 points respectively ( Figure 2 ).…”

“…We have presented the descriptive data on a simple ECG score by Chatterjee et al in therapy naïve-cancer patients [ 19 ]. We showed that a higher score is associated with a higher incidence of cardiotoxicity and that an ECG score ≥ 2 has good discriminatory power to predict cardiotoxicity in the ROC analysis.…”

“…A JTc prolongation > 360 ms accounted for 1 point. After assessment of all 4 parameters, the ECG score was calculated by summation ( Figure 1 ) [ 19 ].…”

“… Composition of the ECG score. The table shows the composition of the ECG score developed by Chatterjee et al [ 19 ]. …”

“…Risk assessment by scoring systems is a part of personalized precision medicine and therefore should be part of modern cardio-oncology. More recently, a simple ECG score was developed to improve the prediction of sudden and/or arrhythmic death (SAD) in patients with CAD [ 19 ]. The authors analyzed the data of more than 7000 patients from a large registry database (PRE-DETERMINE) and a prospective study (ARTEMIS) to develop a simple ECG score composed of four ECG measures incorporated into a standard 12-lead ECG analysis.…”