Early repolarization pattern in patients with malignant coronary artery anomalies

Potentially malignant coronary artery anomalies (CAAs) are single coronary artery, myocardial bridges with deep course, ALCAPA, large or multiple fistulas, and anomalous coronary artery from the opposite sinus, interarterial course (IAC) anomalies, which can lead to life-threatening complications. It is well-known that the early repolarization pattern (ERP) is associated with sudden cardiac death (SCD).This investigation aimed to assess the relationship between ERP and poor cardiac outcomes in patients with malignant CAAs.

Imaging findings, electrocardiographic features, clinical details, and long-term outcomes were retrospectively assessed. The primary outcome was measured as major adverse cardiac events (MACE), defined as a combination of fatal ventricular arrhythmias (VAs), syncope, or SCD. The secondary endpoint was described as a combination of fatal VAs or SCD.The study population was divided into 2 groups: MACE (+) and MACE (-).

A total of 139 patients with malignant CAAs [mean age: 54.54 ± 12.46 years; male:73 (52.5%)] were included in this study.At least one MACE occurred in 16 (11.5%) patients during follow-up. The frequencies of IAC anomalies (68.8 vs 39.0%, p = 0.024) and ERP (50 vs 14.6%, p = 0.002) were notably higher in the MACE (+) group than the others.The penalized Cox regression analysis demonstrated that ERP (HR = 4.06, 95%CI: 1.44-11.44, p = 0.008 for MACE, and HR = 6.45, 95%CI: 1.56-26.66, p = 0.008 for SCD or fatal VAs) was found to be an independent predictor of primary and secondary endpoints.

The present study suggests that ERP may be associated with poor outcomes; however, causality cannot be inferred due to the retrospective observational design.