Journal of Electrocardiology
Volume 43, Issue 4 , Pages 351-358, July 2010

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☆

  • Sean van Diepen, MD

      Affiliations

    • Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
    • ,
  • Hany Siha, MD

      Affiliations

    • Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
    • ,
  • Yuling Fu, MD

      Affiliations

    • Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
    • ,
  • Cynthia M. Westerhout, PhD

      Affiliations

    • Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
    • ,
  • Renato D. Lopes, MD

      Affiliations

    • Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
    • ,
  • Christopher B. Granger, MD

      Affiliations

    • Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
    • ,
  • Paul W. Armstrong, MD

      Affiliations

    • Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
    • Corresponding Author InformationCorresponding author. Division of Cardiology, 251 Medical Sciences Building, University of Alberta, Edmonton, Alberta, Canada, T6G 2H7.
    • ,
  • for the APEX AMI Investigators

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.

Keywords: Atrial fibrillation, Atrial infarction, Myocardial infarction

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☆ 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.

PII: S0022-0736(10)00185-8

doi:10.1016/j.jelectrocard.2010.04.001

Journal of Electrocardiology
Volume 43, Issue 4 , Pages 351-358, July 2010

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