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.
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.
van Diepen
Sean
S
Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada.
Siha
Hany
H
Fu
Yuling
Y
Westerhout
Cynthia M
CM
Lopes
Renato D
RD
Granger
Christopher B
CB
Armstrong
Paul W
PW
D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000401:mortality* / Q000517:prevention & control; D015897:Comorbidity; D004562:Electrocardiography / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality*; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D057127:Single-Chain Antibodies / Q000008:administration & dosage*; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D057127:Single-Chain Antibodies; C402724:pexelizumab