Document Detail


Determinants of prolonged QT interval and their contribution to sudden death risk in coronary artery disease: the Oregon Sudden Unexpected Death Study.
MedLine Citation:
PMID:  19171855     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: In a recent cohort study, prolongation of the corrected QT interval (QTc) was associated with an independent increased risk of sudden cardiac death (SCD). We evaluated determinants of prolonged QTc and the relationship of prolonged QTc to SCD risk among patients with coronary artery disease in the general population.
METHODS AND RESULTS: A case-control design was used. Cases were SCD patients with coronary artery disease among a metropolitan area of 1 000 000 residents (2002 to 2006); controls were area residents with coronary artery disease but no history of SCD. All cases were required to have an ECG suitable for QTc analysis before and unrelated to the occurrence of SCD. A total of 373 cases and 309 controls met criteria for analysis. Mean QTc was significantly longer in cases than in controls (450+/-45 versus 433+/-37 ms; P<0.0001). In a multivariate model, gender, diabetes mellitus, and QTc-prolonging drugs were significant determinants of QTc prolongation in controls. In a logistic regression model predicting SCD, diabetes mellitus (odds ratio, 1.97; 95% confidence interval, 1.32 to 2.96) and use of QTc-prolonging drugs (odds ratio, 2.90; 95% confidence interval, 1.92 to 4.37) were significant predictors of SCD among subjects with normal or borderline QTc. However, abnormally prolonged QTc in the absence of diabetes and QT-prolonging medications was the strongest predictor of SCD (odds ratio, 5.53; 95% confidence interval, 3.20 to 9.57).
CONCLUSIONS: Diabetes mellitus and QTc-affecting drugs determined QTc prolongation and were predictors of SCD in coronary artery disease. However, idiopathic abnormal QTc prolongation was associated with 5-fold increased odds of SCD. A continued search for novel determinants of QTc prolongation such as genomic factors is likely to enhance risk stratification for SCD in coronary artery disease.
Authors:
Sumeet S Chugh; Kyndaron Reinier; Tejwant Singh; Audrey Uy-Evanado; Carmen Socoteanu; Dawn Peters; Ronald Mariani; Karen Gunson; Jonathan Jui
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2009-01-26
Journal Detail:
Title:  Circulation     Volume:  119     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-02-10     Completed Date:  2009-03-06     Revised Date:  2013-06-02    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  663-70     Citation Subset:  AIM; IM    
Affiliation:
Cardiac Arrhythmia Center, Division of Cardiovascular Medicine, Oregon Health and Science University, Portland, USA. sumeet.chugh@cshs.org
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Case-Control Studies
Coronary Artery Disease / mortality*
Death, Sudden, Cardiac / epidemiology*
Electrocardiography*
Female
Humans
Logistic Models
Long QT Syndrome / diagnosis*,  mortality*
Male
Middle Aged
Oregon / epidemiology
Predictive Value of Tests
Risk Factors
Grant Support
ID/Acronym/Agency:
R01 HL088416-03/HL/NHLBI NIH HHS; R01 HL088416-05/HL/NHLBI NIH HHS; R01-HL088416/HL/NHLBI NIH HHS
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