Prognostic significance of abnormal P wave morphology and PR-segment displacement after ST-elevation myocardial
Marvin Louis Roy Lu1, Chinualumogu Nwakile2, Vikas Bhalla2
1Einstein Medical Center, Philadelphia, PA, United States.
Insights
Electrocardiogram (ECG) changes, specifically abnormal P waves and PR segment displacement, are linked to increased mortality in ST-elevation myocardial infarction (STEMI) patients. These atrial ECG findings independently predict higher 30-day and 1-year mortality rates.
Area of Science:
- Cardiology
- Medical Diagnostics
- Clinical Research
Background:
- Atrial infarction is a rare condition with limited data on its clinical significance.
- Atrial electrocardiogram (ECG) changes in ST-elevation myocardial infarction (STEMI) have been linked to mortality, but short-term and long-term associations are not well-studied.
Purpose of the Study:
- To investigate the association between atrial ECG patterns and mortality in STEMI patients.
- To determine if specific atrial ECG changes predict 30-day and 1-year mortality after STEMI.
Main Methods:
- Analysis of index ECGs in 224 consecutive STEMI patients.
- Collection of demographic, clinical, troponin I, ejection fraction, and angiographic data.
- Examination of atrial ECG patterns and correlation with mortality outcomes.
Main Results:
- Abnormal P wave morphology and PR segment displacement were associated with longer hospital stays and higher prevalence of left main coronary disease.
- Both abnormal P waves and PR displacement independently predicted increased 30-day and 1-year mortality.
- PR displacement in any lead independently predicted 1-year mortality after adjusting for key clinical factors (adjusted OR 6.22).
Conclusions:
- PR segment displacement, identified in 31% of STEMI patients, is an independent predictor of 1-year mortality.
- Atrial ECG abnormalities provide valuable prognostic information in STEMI.
- Further research into atrial involvement in myocardial infarction is warranted.
Introduction:
Atrial infarction is uncommonly diagnosed and data on its significance are limited. Its incidence in ST-elevation myocardial infarction (STEMI) reportedly ranges from 0.7-42%. Certain atrial ECG changes, such as abnormal P wave morphology suggestive of atrial involvement have been associated with 90-day mortality after STEMI. However, whether atrial ECG changes are associated with short (30-day) or long-term (1-year) mortality have not been studied.
Methods:
We examined index ECG in 224 consecutive STEMI. Demographics, clinical variables, peak troponin I, ejection fraction, and angiographic data were collected. Atrial ECG patterns were examined and correlated with mortality.
Results:
Length of stay was longer with abnormal P waves (p=0.008) or PR displacement in any lead (p=0.003). Left main coronary disease was more prevalent with abnormal P wave (p=0.045). Abnormal P wave morphology in any lead was associated with higher 30-day (OR 3.09 (1.35-7.05)) and 1-year mortality (OR 5.33 (2.74-10.36)). PR displacement in any lead was also associated with increased 30-day (OR 2.33 (1.03-5.28)) and 1-year mortality (OR 6.56 (3.34-12.86)). Abnormal P wave, PR depression in II, III and AVF, and elevation in AVR or AVL were associated with increased 1-year mortality (OR 12.49 (5.2-30.0)) as was PR depression in the precordial leads (OR 21.65 (6.82-68.66)). After adjusting for age, ejection fraction, peak troponin I, and left main disease, PR displacement in any lead was associated with increased 1-year mortality (adjusted OR 6.22 (2.33-18.64)).
Conclusion:
PR segment displacement in any lead, found in 31% of patients with STEMI, independently predicted 1-year mortality.
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