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☆
Received 10 February 2010 published online 05 May 2010.
Abstract
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.
aDivision of Cardiology, University of Alberta, Edmonton, Alberta, Canada
bDuke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
Corresponding author. Division of Cardiology, 251 Medical Sciences Building, University of Alberta, Edmonton, Alberta, Canada, T6G 2H7.
☆ Financial support: The APEX-AMI trial, from which this work was derived, was supported by a research grant jointly funded from Procter & Gamble and Alexion Pharmaceuticals.
ABSTRACT