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European Heart Journal Advance Access published online on January 23, 2009
European Heart Journal, doi:10.1093/eurheartj/ehn584
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Asymptomatic ST-segment depression during exercise testing and the risk of sudden cardiac death in middle-aged men: a population-based follow-up study

Jari A. Laukkanen1,2,*, Timo H. Mäkikallio2,3, Rainer Rauramaa4,5 and Sudhir Kurl1

1 Research Institute of Public Health, University of Kuopio, PO Box 1627, 70211 Kuopio, Finland
2 Lapland Central Hospital, Rovaniemi, Finland
3 Division of Cardiology, Department of Internal Medicine, University of Oulu, Oulu, Finland
4 Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
5 Department of Clinical Physiology and Nuclear Medicine, University Hospital of Kuopio, Kuopio, Finland

Received 12 August 2008; revised 24 November 2008; accepted 11 December 2008.

* Corresponding author. Tel: +358 17 162 910, Fax: +358 17 162 936, Email: jariantero.laukkanen{at}uku.fi

Aims: Silent electrocardiographic ST change predicts future coronary events in patients with coronary heart disease (CHD), but the prognostic significance of asymptomatic ST-segment depression with respect to sudden cardiac death in subjects without apparent CHD is not well known.

Methods and results: We investigated the association between silent ST-segment depression during and after maximal symptom-limited exercise test and the risk of sudden cardiac death in a population-based sample of 1769 men without evident CHD. A total of 72 sudden cardiac death occurred during the median follow-up of 18 years. The risk of sudden cardiac death was increased among men with asymptomatic ST-segment depression during exercise [hazard ratio (HR) 2.1, 95% confidence interval (CI) 1.2–3.9] as well as among those with asymptomatic ST-segment depression during recovery period (HR 3.2, 95% CI 1.7–6.0). Asymptomatic ST-depression during exercise testing was a stronger predictor for the risk of sudden cardiac death especially among smokers as well as in hypercholesterolaemic and hypertensive men than in men without these risk factors.

Conclusion: Asymptomatic ST-segment depression was a very strong predictor of sudden cardiac death in men with any conventional risk factor but no previously diagnosed CHD, emphasizing the value of exercise testing to identify asymptomatic high-risk men who could benefit from preventive measures.

Key Words: Exercise electrocardiography • Sudden death • Risk factors


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