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In the second study (26), 30 patients with a first MI complicated by primary VF were compared to 30 age- and sex-matched Staurosporine patients with a first uncomplicated MI (26). On the ECG performed 5 days after MI, ER was significantly more frequently observed among the 30 VF cases compared with the 30 controls (14 [47%] vs. 4 [3%], p?= 0.05). All 14 patients with VF, and also 3 of the 4 patients with uncomplicated infarction, had the horizontal pattern (26). The third and largest study on this issue compared 432 victims of out-of-hospital sudden death (believed to be due to a fatal arrhythmogenic MI), with 532 patients with a nonfatal MI (25). Clinical correlates of?a fatal?arrhythmic outcome were male sex, younger age, lower body?mass index, current smoking status, and nonuse of beta-blockers and other cardiac medications, whereas a history of prior angina or prior MI actually correlated with a nonfatal outcome (25). The presence of ER on a pre-morbid ECG strongly correlated with a fatal outcome even after adjusting for gender and age (25). Specifically, the ER pattern with a horizontal ST segment (but not with Smad inhibitor an ascending pattern) was an independent predictor of sudden death (odds ratio: 2.15, 95% confidence interval: 1.20 to 3.85) (25). The ER has also been linked to higher cardiac death and arrhythmic death rates in vasospastic angina (28). Of 281 consecutive patients with documented vasospastic angina, 60 (21%) had ER during a remote ECG (recorded before or long after the ischemic event). Subjects with ER and horizontal ST-segment had a higher age- and sex-adjusted risk for cardiac events (mainly arrhythmic death) with a hazard ratio of 8. In contrast, persons with the ascending type of ER did not have an increased risk for arrhythmic events during coronary spasm induced myocardial ischemia (28). We recently reviewed all published reports EPZ5676 that have ECG illustrations of idiopathic VF and found 89?ECG traces with ER. In accordance with our own experience (see following text), in 70 (78%) of cases with malignant ER, the ST-segment was horizontal (D. Viskin, unpublished data). In our own case-control series of idiopathic VF, ER was?more prevalent among patients with idiopathic VF than?among age- and sex-matched controls (42% vs. 13%, p?