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Early repolarization pattern in patients with malignant coronary artery anomalies

Ezgi Gültekin Güner1, Ahmet Güner1, Önder Turna2

  • 1Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye.

Journal of Electrocardiology
|April 20, 2026
PubMed

Insights

Early repolarization pattern (ERP) is linked to poor cardiac outcomes in patients with malignant coronary artery anomalies (CAAs). This retrospective study found ERP independently predicted major adverse cardiac events (MACE) and sudden cardiac death (SCD).

Area of Science:

  • Cardiology
  • Cardiac Electrophysiology
  • Medical Imaging

Background:

  • Potentially malignant coronary artery anomalies (CAAs) can cause life-threatening complications.
  • Early repolarization pattern (ERP) is a known risk factor for sudden cardiac death (SCD).
  • The association between ERP and adverse outcomes in malignant CAAs requires further investigation.

Purpose of the Study:

  • To evaluate the relationship between ERP and poor cardiac outcomes in patients diagnosed with malignant CAAs.
  • To identify electrocardiographic predictors of major adverse cardiac events (MACE) in this patient cohort.

Main Methods:

  • Retrospective analysis of imaging findings, electrocardiographic features, clinical data, and long-term outcomes.
  • Primary outcome: Major Adverse Cardiac Events (MACE) including fatal ventricular arrhythmias (VAs), syncope, or SCD.
  • Secondary outcome: Fatal VAs or SCD. Patients were grouped as MACE (+) or MACE (-).

Main Results:

  • 139 patients with malignant CAAs were included (mean age 54.5 years, 52.5% male).
  • 11.5% of patients experienced at least one MACE.
  • Interarterial course (IAC) anomalies and ERP were significantly more frequent in the MACE (+) group.
  • ERP was an independent predictor of MACE (HR=4.06) and SCD/fatal VAs (HR=6.45).

Conclusions:

  • Early repolarization pattern (ERP) may be associated with adverse cardiac outcomes in patients with malignant coronary artery anomalies (CAAs).
  • ERP is an independent predictor for MACE and SCD/fatal VAs in this population.
  • Causality cannot be established due to the retrospective observational nature of the study.
Abstract

Keywords:
Early repolarizationInterarterial courseMalignant coronary artery anomaliesSudden cardiac deathVentricular arrhythmia

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