Coronary artery disease
Relation of Atrial and/or Ventricular Premature Complexes on a Two-Minute Rhythm Strip to the Risk of Sudden Cardiac Death (the Atherosclerosis Risk in Communities [ARIC] Study)

https://doi.org/10.1016/j.amjcard.2010.09.002Get rights and content

Ventricular premature complexes (VPCs) and atrial premature complexes (APCs) are common findings on routinely obtained electrocardiograms. Despite their common occurrence, the significance of these irregular beats is unclear, especially with regard to risk of sudden cardiac death (SCD). In this study, we examined the prospective relation between baseline VPCs or APCs and SCD, myocardial infarction, and fatal coronary heart disease (CHD) in a population-based sample of subjects from the Atherosclerosis Risk in Communities (ARIC) study excluding participants with known history of CHD or stroke. Baseline examination was conducted from 1987 to 1989, with follow-up data regarding clinical cardiac events collected until December 2002. The total study population was 14,574 subjects. Kaplan-Meier curves and computed univariate and multivariate Cox proportional hazard models were employed to estimate the effect of VPC and APC occurrences on incident cardiac events. During the follow-up period, there were 130 incident cases of SCD, 1,657 incident cases of CHD cases, and 288 cases of fatal CHD. Participants with VPC were 2 times as likely to have SCD (hazard ratio [HR] 2.09, 95% confidence interval [CI] 1.22 to 3.56) compared to those without VPC. Presence of APC was not significantly associated with SCD (HR 1.15, 95% CI 0.56 to 2.39). Compared to subjects without VPC and APC, risk of SCD in subjects with VPC and APC was significantly increased (HR 6.39, 95% CI 2.58 to 15.84). In conclusion, our study shows that subjects with VPCs are significantly more likely to die from SCD, despite not having any known history of cardiovascular disease. This effect appears to be additive when APCs occur concurrently.

Section snippets

Methods

We used public-use data from the Atherosclerosis Risk in Communities (ARIC) study, an ongoing prospective study of the cause and natural history of atherosclerosis funded by the National Heart, Lung, and Blood Institute (NHLBI). Four communities took part in the investigation: Forsyth County, North Carolina; Jackson, Mississippi; suburban Minneapolis, Minnesota; and Washington County, Maryland. The total population of the study, conducted from 1987 to 1989, was 15,732 subjects 45 to 64 years of

Results

The ARIC pubic-use data included 15,732 participants. We excluded 1,158 subjects who had prevalent CHD or stroke at baseline or whose baseline 2-minute electrocardiogram was of poor quality. As a result, our analysis consisted of 14,574 middle-aged Americans free of CHD and stroke at baseline. They were followed to December 31, 2002 for incident cardiac events including SCD, CHD, and fatal CHD, an average of 14 years. Median follow-up time of the study was 14 years (interquartile range 1.5). Of

Discussion

In this prospective study we report 3 major findings. First, presence of any VPC on a 2-minute rhythm strip at baseline was associated with significantly increased risk of SCD, incident CHD, and fatal CHD in middle-aged Americans who did not have a history of CHD or stroke. Furthermore, after fully adjusting for known risk factors, those patients with VPCs were 2 times as likely to develop a fatal CHD or SCD. The similar magnitude of risks is largely due to the significant overlap of incidence

Acknowledgment

We thank the NHLBI, ARIC investigators and participants for their important contributions and also for making available public use data. We extend our thanks to our librarian, Laurie Schwing, MLS and Daniel Fischman, MD, MMM for helping us in editing and producing the final draft.

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