 |
|
Prolonged QTc Interval and Risks of Total and Cardiovascular Mortality and Sudden Death in the General Population
A Review and Qualitative Overview of the Prospective Cohort Studies
Alicia Montanez, MD;
Jeremy N. Ruskin, MD;
Patricia R. Hebert, PhD;
Gervasio A. Lamas, MD;
Charles H. Hennekens, MD, DrPH
Arch Intern Med. 2004;164:943-948.
Background In certain subgroups of patients, prolongation of the QTc interval may increase total and cardiovascular mortality due to life-threatening ventricular arrhythmias and sudden death. Nonetheless, whether modest prolongation of the QTc interval in the general population has clinical importance remains unclear.
Methods We conducted a literature search from 1990 forward to identify all published prospective cohort studies evaluating the association between prolonged QTc interval and risks of total and cardiovascular mortality as well as sudden death. We reviewed each of the studies individually and then conducted a qualitative overview.
Results The 7 prospective cohort studies identified included 36 031 individuals. There were 2677 (8.7%) individuals with prolonged QTc interval, defined as 440 milliseconds or greater. Whereas 1 study reported no association between prolonged QTc interval and mortality (relative risk, 1.02; 95% confidence interval, 0.70-1.49), the other 6 reported inconsistent associations overall as well as across subgroups defined by various characteristics including age, sex, and comorbidities. The reported associations for both cardiovascular mortality and sudden death were also inconsistent. In the overview, the only consistent findings were for the subgroup of patients with prior cardiovascular disease, in which relative risks ranged from 1.1 to 3.8 for total mortality, from 1.2 to 8.0 for cardiovascular mortality, and from 1.0 to 2.1 for sudden death. Further, in individuals without prior cardiovascular disease, associations were either absent or greatly attenuated; specifically, relative risks ranged from 0.9 to 1.6 for total mortality, from 1.2 to 1.7 for cardiovascular mortality, and from 1.3 to 2.4 for sudden death.
Conclusions There was no consistent evidence for increased risks of total or cardiovascular mortality or of sudden death, except perhaps for patients with prior cardiovascular disease. In the general population, if QTc interval prolongation is associated with any increase in mortality, that risk is likely to be small and difficult to detect reliably.
From the Division of Cardiovascular Research, Mount Sinai Medical Center and Miami Heart Institute, Miami Beach, Fla (Drs Montanez and Lamas); the Departments of Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston (Dr Ruskin); Internal Medicine, Yale University School of Medicine, New Haven, Conn (Dr Hebert); Medicine (Drs Lamas and Hennekens), and Epidemiology & Public Health (Dr Hennekens), University of Miami School of Medicine, Miami, Fla; and the Agatston Research Institute, Providence, RI (Dr Hennekens). The authors have no relevant financial interest in this article.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Drug-Induced Long QT Syndrome in Injection Drug Users Receiving Methadone: High Frequency in Hospitalized Patients and Risk Factors.
Ehret et al.
Arch Intern Med 2006;166:1280-1287.
ABSTRACT
| FULL TEXT
Prognostic Impact of Prolonged Ventricular Repolarization in Hypertension.
Schillaci et al.
Arch Intern Med 2006;166:909-913.
ABSTRACT
| FULL TEXT
QTc interval and survival in 75-year-old men and women from the general population.
Nilsson et al.
Europace 2006;8:233-240.
ABSTRACT
| FULL TEXT
Sudden cardiac death and antipsychotics. Part 2: Monitoring and prevention
Abdelmawla and Mitchell
Adv. Psychiatr. Treat. 2006;12:100-109.
ABSTRACT
| FULL TEXT
Prolonged QTc Interval and Risk of Sudden Cardiac Death in a Population of Older Adults
Straus et al.
J Am Coll Cardiol 2006;47:362-367.
ABSTRACT
| FULL TEXT
Sudden cardiac death and antipsychotics. Part 1: Risk factors and mechanisms
Abdelmawla and Mitchell
Adv. Psychiatr. Treat. 2006;12:35-44.
ABSTRACT
| FULL TEXT
Sudden cardiac death in diabetes mellitus: risk factors in the Rochester diabetic neuropathy study
Suarez et al.
J. Neurol. Neurosurg. Psychiatry 2005;76:240-245.
ABSTRACT
| FULL TEXT
JournalScan
Malik
Heart 2004;90:967-968.
FULL TEXT
|
