Demidova Marina M, Olivecrona Goran, Gorgels Anton P M, Erlinge David, Platonov Pyotr G
Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
Department of Cardiology, Maastricht University, Maastricht, the Netherlands.
Int J Cardiol Heart Vasc. 2025 Apr 26;58:101668. doi: 10.1016/j.ijcha.2025.101668. eCollection 2025 Jun.
Atrial fibrillation (AF) often complicates ST-elevation myocardial infarction (STEMI). Atrial ischemia due to non-perfused atrial branches may contribute to its underlying mechanisms. We aimed to assess the association between atrial branches perfusion during STEMI and AF occurrence during and after STEMI.
We performed a single-center retrospective register-based cohort study. Consecutive STEMI patients admitted for percutaneous coronary interventions (PCI) during 2007-2010 were included (n = 1960, age 65 ± 12 years, 71 % male) and followed up for 10 years. Clinical characteristics were retrieved from the Swedish national registries. ECGs recorded before, during or after STEMI were exported from a digital archive. Patients with AF documented prior to STEMI and AF after CABG during hospitalization for STEMI were excluded. The endpoint was the first AF episode either during hospitalization or after discharge.
Non-perfused atrial branches were observed in 59 out of 212 proximal RCA occlusions and in 4 out of 93 proximal LCX occlusions. All other culprit vessels (n = 1,655) were presumed to be unrelated to atrial perfusion. The absence of atrial branch perfusion was not associated with new-onset AF either during hospitalization or after discharge (HR = 0.79, 95 % CI 0.35-1.78, p = 0.570).
The lack of atrial branch perfusion during STEMI was not associated with new-onset AF either during or after STEMI.
心房颤动（AF）常并发于ST段抬高型心肌梗死（STEMI）。未灌注的心房分支导致的心房缺血可能是其潜在机制之一。我们旨在评估STEMI期间心房分支灌注与STEMI期间及之后AF发生之间的关联。
我们进行了一项基于单中心回顾性登记的队列研究。纳入2007年至2010年期间因接受经皮冠状动脉介入治疗（PCI）而入院的连续STEMI患者（n = 1960，年龄65±12岁，71%为男性），并随访10年。临床特征从瑞典国家登记处获取。STEMI之前、期间或之后记录的心电图从数字存档中导出。排除STEMI之前记录有心房颤动以及在STEMI住院期间冠状动脉旁路移植术（CABG）后发生心房颤动的患者。终点是住院期间或出院后首次发生的AF发作。
在212例近端右冠状动脉（RCA）闭塞中有59例观察到未灌注的心房分支，在93例近端左旋支（LCX）闭塞中有4例观察到未灌注的心房分支。所有其他罪犯血管（n = 1655）被认为与心房灌注无关。心房分支灌注缺失与住院期间或出院后新发AF均无关联（风险比[HR]=0.79，95%置信区间[CI]0.35 - 1.78，p = 0.570）。
STEMI期间心房分支灌注缺乏与STEMI期间或之后的新发AF均无关联。
