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.

中文翻译：

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简单的心电图测量可改善冠心病猝死的预测

目的 确定反映心律失常风险领域的标准心电图 (ECG) 标志物的组合是否能改善冠心病 (CHD) 患者的猝死和/或心律失常 (SAD) 风险分层。方法和结果 在调整临床危险因素、左心室射血分数 (LVEF) 和竞争风险的推导队列（PREDETERMINE；N = 5462）中检查 ECG 标志物与 SAD 之间的关联。竞争结果模型评估了心电图标志物与 SAD 和竞争死亡率的差异关联。然后验证衍生的 ECG 评分的预测值（ARTEMIS；N = 1900）。在推导队列中，低危和高危心电图患者的 SAD 5 年累积发生率为 1.5% [95% 置信区间 (CI) 1.1-1.9] 和 6.2% (95% CI 4.5-8.3)分数，分别为 (P 为 Δ < 0.001)。与非 SAD 死亡率相比，高风险 ECG 评分与 SAD 死亡率的相关性更强（调整后的风险比分别为 2.87 和 1.38；Δ P = 0.003），并且 SAD 导致的死亡比例在高与低之间更大风险组（24.9% 对 16.5%，Δ 的 P = 0.03）。在验证队列中观察到类似的发现。在包括 LVEF 在内的临床风险因素模型中添加 ECG 标志物改善了推导和验证队列中的区分和重新分类指数，包括验证队列中 28% 的患者正确重新分类 [净重新分类改善 28 (7-49%) , P = 0.009]。结论 对于冠心病患者，与标准临床风险因素（包括 LVEF）相比，外部验证的 ECG 评分丰富了绝对和成比例的 SAD 风险，并显着改善了风险分层。临床试验注册 https://clinicaltrials.gov/ct2/show/NCT01114269。ClinicalTrials.gov ID NCT01114269。