Impact of age and sex on the long-term prognosis associated with early repolarization in the general population

Abstract Background Early repolarization (ER) has been linked to the risk of sudden cardiac death (SCD) in the general population, although controversy remains regarding risks across various subgroups. Objective We investigated whether age and sex influence the prognostic significance of ER. Methods We evaluated the 12-lead electrocardiograms of 6631 Finnish general population subjects aged ≥30 years (mean age 50.1 ± 13.9 years, 44.5% men) for the presence of ER (J-point elevation ≥0.1 mV in ≥2 inferior/lateral leads), following them for 24.4 ± 10.3 years. We analyzed the association between ER and the risk of SCD, cardiac death, and all-cause mortality in subgroups according to age ( Results ER was present in 367 of the 3305 subjects under 50 and in 426 of 3326 subjects aged ≥50 years. ER was not associated with any of the endpoints in the entire study population. After adjusting for clinical factors, ER was associated with SCD (hazard ratio [HR] 1.88; 95% confidence interval [CI] 1.16–3.07) in subjects under 50, but not in older subjects (interaction between ER and age group, P = .048). Among the younger subgroup, women with ER had a high risk of SCD (HR 4.11; 95% CI 1.41–12.03), whereas among men ER was not associated with SCD. Finally, ER was not associated with cardiac mortality or all-cause mortality in either age group. Conclusion ER associates with SCD in subjects younger than 50 years, particularly in women, but not in subjects 50 years and older.