Association between early repolarization and coronary slow flow phenomenon.

BACKGROUND: Early repolarization pattern (ERP) has been associated with electrical instability, while coronary slow flow phenomenon (CSFP) reflects delayed contrast transit without obstructive coronary disease. We evaluated the association between ERP, quantitative repolarization markers, and CSFP. METHODS: This retrospective study screened 753 patients who underwent coronary angiography. After applying the inclusion and exclusion criteria, 50 patients aged 18-60 years were included in the final cohort. CSFP was defined as a corrected TIMI frame count (CTFC) >27 in at least one epicardial artery. Electrocardiograms were reviewed for the presence of ERP and quantitative repolarization markers. Group comparisons and univariable logistic regression. RESULTS: Among 50 patients selected for quantitative CTFC analysis, 32 (64%) met criteria for CSFP. ERP was more frequent in patients with CSFP than in those with normal CTFC (71.9% vs. 22.2%, p < 0.005) and was associated with CSFP in univariable analysis (OR 8.94, 95% CI 2.31-34.58). T-wave and J-peak amplitudes were also higher in the CSFP group and were associated with CSFP per 0.1 mV increase (T-wave amplitude: OR 2.87, 95% CI 1.47-5.59; J-peak amplitude: OR 42.44, 95% CI 6.08-296.26). Male sex and higher hemoglobin were also associated with CSFP in univariable analyses. The wide confidence intervals, particularly for J-peak amplitude and male sex, reflect the limited precision of these estimates given the modest sample size. CONCLUSION: ERP and quantitative repolarization markers were associated with CTFC-defined CSFP in this selected cohort. The findings suggest a potential relationship between ventricular repolarization features and delayed coronary transit but should be considered exploratory and hypothesis-generating.