title: The predictive value of P-wave duration by signal-averaged electrocardiogram in acute ST elevation myocardial infarction.
abstract: BACKGROUND
  The prognostic value of P-wave duration has been previously evaluated by signal-averaged ECG (SAECG) in patients with various arrhythmias not associated with acute myocardial infarction (AMI).
  
  
  OBJECTIVE
  To investigate the clinical correlates and prognostic value of P-wave duration in patients with ST elevation AMI (STEMI).
  
  
  METHODS
  The patients (n = 89) were evaluated on the first, second and third day after admission, as well as one week and one month post-AMI. Survival was determined 2 years after the index STEMI.
  
  
  RESULTS
  In comparison with the upper normal range of P-wave duration (<120 msec), the P-wave duration in STEMI patients was significantly increased on the first day (135.31 +/- 29.29 msec, P < 0.001), up to day 7 (127.17 +/- 30.02 msec, P = 0.0455). The most prominent differences were observed in patients with left ventricular ejection fraction (LVEF) < or = 40% (155.47 +/- 33.8 msec), compared to LVEF > 40% (128.79 +/- 28 msec) (P = 0.001). P-wave duration above 120 msec was significantly correlated with increased complication rate; namely, sustained ventricular tachyarrhythmia (36%), congestive heart failure (41%), atrial fibrillation (11%), recurrent angina (14%), and re-infarction (8%) (P = 0.012, odds ratio 4.267, 95% confidence interval 1.37-13.32). P-wave duration of 126 msec on the day of admission was found to have the highest predictive value for in-hospital complications including LVEF 40% (area under the curve 0.741, P < 0.001). However, we did not find a significant correlation between P-wave duration and mortality after multivariate analysis.
  
  
  CONCLUSIONS
  P-wave duration as evaluated by SAECG correlates negatively with LVEF post-STEMI, and P-wave duration above 126 msec can be utilized as a non-invasive predictor of in-hospital complications and low LVEF following STEMI.
authors.affiliation: Department of Cardiology, Western Galilee Hospital, Nahariya, Israel.
authors.forename: Alexander
authors.initials: A
authors.lastname: Shturman
authors.forename: Amitai
authors.initials: A
authors.lastname: Bickel
authors.forename: Shaul
authors.initials: S
authors.lastname: Atar
mesh_terms: D000787:Angina Pectoris / Q000150:complications; D001281:Atrial Fibrillation / Q000150:complications; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D011379:Prognosis; D012008:Recurrence; D013318:Stroke Volume; D017180:Tachycardia, Ventricular / Q000150:complications