University of Oulu

Holkeri A, Eranti A, Haukilahti MAE, et al. Heart, 2020;106:427–433,

Predicting sudden cardiac death in a general population using an electrocardiographic risk score

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Author: Holkeri, Arttu1; Eranti, Antti2; Haukilahti, M. Anette E.3;
Organizations: 1Division of Cardiology, Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
2Heart Center, North Karelia Central Hospital, Joensuu, Finland
3Research Unit of Internal Medicine, Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
4Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland
5Center for Machine Vision and Signal Analysis, University of Oulu, Oulu, Finland
6Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.6 MB)
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Language: English
Published: BMJ, 2019
Publish Date: 2020-04-29


Objective: We investigated whether combining several ECG abnormalities would identify general population subjects with a high sudden cardiac death (SCD) risk.

Methods: In a sample of 6830 participants (mean age 51.2±13.9 years; 45.5% male) in the Mini-Finland Health Survey, a general population cohort representative of the Finnish adults aged ≥30 years conducted in 1978—1980, we examined their ECGs, following subjects for 24.3±10.4 years. We analysed the association between individual ECG abnormalities and 10-year SCD risk and developed a risk score using five ECG abnormalities independently associated with SCD risk: heart rate >80 beats per minute, PR duration >220 ms, QRS duration >110 ms, left ventricular hypertrophy and T-wave inversion. We validated the score using an external general population cohort of 10 617 subjects (mean age 44.0±8.5 years; 52.7% male).

Results No ECG abnormalities were present in 4563 subjects (66.8%), while 96 subjects (1.4%) had ≥3 ECG abnormalities. After adjusting for clinical factors, the SCD risk increased progressively with each additional ECG abnormality. Subjects with ≥3 ECG abnormalities had an HR of 10.23 (95% CI 5.29 to 19.80) for SCD compared with those without abnormalities. The risk score similarly predicted SCD risk in the validation cohort, in which subjects with ≥3 ECG abnormalities had HR 10.82 (95% CI 3.23 to 36.25) for SCD compared with those without abnormalities.

Conclusion: The ECG risk score successfully identified general population subjects with a high SCD risk. Combining ECG risk markers may improve the risk stratification for SCD.

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Series: Heart
ISSN: 1355-6037
ISSN-E: 1468-201X
ISSN-L: 1355-6037
Volume: 106
Issue: 6
Pages: 427 - 433
DOI: 10.1136/heartjnl-2019-315437
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: This work was supported by the Aarne Koskelo Foundation, Helsinki, Finland (AH); Emil Aaltonen’s Foundation, Tampere, Finland (AE); the Jane and Aatos Erkko Foundation, Helsinki, Finland (HVH); the Finnish Foundation for Cardiovascular Research, Helsinki, Finland (HVH); the Finnish Medical Foundation, Helsinki, Finland (AE and ALA); the Paavo Ilmari Ahvenainen Foundation, Helsinki, Finland (AH); the Sigrid Juselius Foundation, Helsinki, Finland (ALA, AH and HVH); Paavo Nurmi’s Foundation, Helsinki, Finland (AE); Onni and Hilja Tuovinen’s Foundation (AE); and the Orion Research Foundation, Espoo, Finland (AE and TK).
Copyright information: © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ. This is the Author's Accepted Manuscript Version of the published article. The Definitive Version of Record can be found online at: