AI Article Synopsis
- The study investigates the impact of P-wave morphology (specifically duration and vector magnitude) on health outcomes in patients with acute anterior myocardial infarction (MI) caused by blockage in the left anterior descending artery.
- Researchers enrolled 426 patients and found a significant cut-off value for predicting complications like heart failure hospitalization and death, using specific P-wave measurements.
- Results showed that patients with high P-wave duration/vector magnitude had a greater risk of adverse outcomes, while age and performance of the heart also played critical roles in predicting these outcomes.
Article Abstract
Background: The impact of P-wave abnormality in acute anterior MI, where the culprit vessel is the left anterior descending artery, remains undetermined. This study aimed to elucidate the impact of P-wave morphology on clinical outcomes in acute anterior MI.
Methods: Patients undergoing emergent percutaneous coronary intervention for acute anterior MI were enrolled between September 2014 and April 2019 (derivation cohort) and May 2019 through July 2023 (validation cohort). P-wave duration (Pd) and P-wave vector magnitude (Pvm) were measured. The Pvm was calculated as the square root of the sum of the squared P-wave magnitudes in leads II and V6 and one-half of the P-wave amplitude in V2. The patients were categorized into high and low Pd/Pvm groups using a statistically derived cut-off value. The endpoint comprised the composite of heart failure (HF) hospitalization and all-cause death.
Results: Consecutive 426 patients were enrolled in this study (derivation cohort, 213 patients; validation cohort, 216 patients). The calculated cut-off value of Pd/Pvm for predicting the clinical endpoint, determined through receiver operating curve analysis, was 793.5 ms/mV (area under the curve [AUC] = 0.85, sensitivity of 73.8 %, and specificity of 94.0 %) in the derivation cohort. Kaplan-Meier analyses revealed a significantly higher risk of the endpoint in patients with high Pd/Pvm than those with low Pd/Pvm in derivation and validation cohorts (Log-rank p < 0.001 and p < 0.001, respectively). Multivariate Cox proportional hazards analysis identified advanced age, elevated Pd/Pvm, and reduced left ventricular ejection fraction as independent and significant factors associated with the endpoint in the validation cohort (p = 0.008, p < 0.001, and p < 0.001, respectively).
Conclusion: High Pd/Pvm was significantly associated with the composite of HF hospitalization and all-cause death after acute anterior MI.
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| http://dx.doi.org/10.1016/j.jelectrocard.2024.153791 | DOI Listing |
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