van Diepen Sean, Siha Hany, Fu Yuling, Westerhout Cynthia M, Lopes Renato D, Granger Christopher B, Armstrong Paul W
Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada.
J Electrocardiol. 2010 Jul-Aug;43(4):351-8. doi: 10.1016/j.jelectrocard.2010.04.001. Epub 2010 May 4.
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.
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.
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).
Abnormal P wave morphology significantly predicted new AF and 90-day mortality in STEMI patients.
据报道，心房梗死在ST段抬高型心肌梗死（STEMI）患者中的发生率为0.7%至52%，其中多达三分之二的患者会发生心房颤动和扑动（AF）。目前缺乏对心电图心房梗死模式的前瞻性验证。因此，在接受直接经皮冠状动脉介入治疗的STEMI患者中，我们研究了基线心房心电图变化或心房梗死模式是否可预测新发AF或死亡率。
在急性心肌梗死中评估培昔单抗试验中进行了一项巢式病例对照研究。新发AF患者与对照组按1:1匹配，并检查基线心房心电图变量。
P波形态异常（心房梗死的刘次要标准）与新发AF显著相关（调整后的比值比为1.68；1.03 - 2.73）。这也与整个病例对照队列中的90天死亡率独立相关（调整后的风险率为1.90；1.04 - 3.46），在新发AF患者中也是如此（调整后的风险率为2.43；1.22 - 4.84）。
P波形态异常显著预测STEMI患者的新发AF和90天死亡率。
