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Predicting sudden cardiac death in a general population using an electrocardiographic risk score
  1. Arttu Holkeri1,
  2. Antti Eranti2,
  3. M Anette E Haukilahti3,
  4. Tuomas Kerola4,
  5. Tuomas V Kenttä3,
  6. Jani T Tikkanen3,
  7. Olli Anttonen4,
  8. Kai Noponen5,
  9. Tapio Seppänen5,
  10. Harri Rissanen6,
  11. Markku Heliövaara6,
  12. Paul Knekt6,
  13. M Juhani Junttila3,
  14. Heikki V Huikuri3,
  15. Aapo L Aro1
  1. 1Division of Cardiology, Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
  2. 2Heart Center, North Karelia Central Hospital, Joensuu, Finland
  3. 3Research Unit of Internal Medicine, Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
  4. 4Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland
  5. 5Center for Machine Vision and Signal Analysis, University of Oulu, Oulu, Finland
  6. 6Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
  1. Correspondence to Dr Arttu Holkeri, Division of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki 00029, Finland; arttu.holkeri{at}


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.

  • electrocardiography
  • ECG
  • epidemiology
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  • 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).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study protocol and the practice of the subjects’ voluntary participation indicating informed consent were approved by the Institutional Review Board (IRB) of National Institute for Health and Welfare (IRB 00007085, Federalwide Assurance (FWA) 00014588).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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