Do baseline atrial electrocardiographic and infarction patterns predict new-onset atrial fibrillation after ST-elevation myocardial infarction? Insights from the Assessment of Pexelizumab in Acute Myocardial Infarction Trial

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• 作者：Sean van Diepen ; Hany Siha ; Yuling Fu ; Cynthia M. Westerhout ; Renato D. Lopes ; Christopher B. Granger ; Paul W. Armstrong ; for the APEX AMI Investigators
• 关键词：Atrial fibrillation ; Atrial infarction ; Myocardial infarction
• 刊名：Journal of Electrocardiology
• 出版年：2010
• 出版时间：July-August 2010
• 年：2010
• 卷：43
• 期：4
• 页码：351-358
• 全文大小：591 K

文摘

Background

Atrial infarction reportedly occurs in 0.7 % to 52 % of ST-elevation myocardial infarctions (STEMIs), up to two thirds of whom develop atrial fibrillation and flutter (AF). Prospective validation of electrocardiographic atrial infarction patterns is lacking. Hence, in STEMI patients treated with primary percutaneous coronary intervention, we examined whether baseline atrial electrocardiographic changes or atrial infarction patterns predicted new AF or mortality.

Methods

Within the Assessment of Pexelizumab in Acute Myocardial Infarction trial, a nested case-control study was conducted. Patients with new AF were matched 1:1 with controls, and baseline atrial electrocardiographic variables were examined.

Results

Abnormal P wave morphology (Liu minor criterion for atrial infarction) was significantly associated with new AF (adjusted odds ratio, 1.68; 1.03-2.73). This was also independently associated with 90-day mortality in the overall case-control cohort (adjusted hazard rate, 1.90; 1.04-3.46) and among patient with new-onset AF (adjusted hazard rate, 2.43; 1.22-4.84).

Conclusions

Abnormal P wave morphology significantly predicted new AF and 90-day mortality in STEMI patients.