Blood Pressure Variability and Atrial Fibrillation in Patients with Acute ST Segment Elevation Myocardial Infarction: The Relation with Left Atrial Electromechanical Delay − A 1-Year Follow-Up Study

Abstract

Purpose

To investigate the association between 24-h blood pressure variability (BPV) and atrial electromechanical delay (EMD) in patients with ST segment elevation myocardial infarction (STEMI) who developed new-onset atrial fibrillation (NOAF).

Materials and Methods

A total of 175 STEMI patients (age 56.6 ± 10.5 years) who underwent primary percutaneous coronary intervention were subjected to in-hospital 24-h ambulatory BP monitoring, comprehensive echocardiography, and assessment of atrial EMD. The parameters of BPV analyzed were: (a) 24-h standard deviation (SD), (b) the coefficient of variation, and (c) the average of the daytime and nighttime SDs weighted for the duration of the daytime and nighttime interval (SD _dn ).

Results

Based on the median of BPV index (SD _dn) = 9.5 mm Hg of all participants, patients were stratified into low and high variability groups (SD _dn: 7.1 ± 1.5 vs.13.5 ± 2.9; p < 0.001). Of the 175 patients with STEMI, 29 (16.7%) patients developed NOAF; 26 (28.9%) were in the high variability group and 3.5% were in the low variability group ( p < 0.001). Echocardiographic data showed that the left atrial volume index ( p < 0.01) and E/e′ ratio ( p < 0.001) were significantly higher in patients with high BPV. Inter and intra-atrial EMD were significantly increased in the high variability group compared to the low variability group ( p < 0.001). With multiple linear analysis, there was significant correlation between SD _dn and intra-left atrial and inter-atrial EMD ( p < 0.001 and <0.01, respectively). Cox regression analysis revealed that SD _dn and intra-atrial EMD were independent predictors for NOAF in patients with STEMI (OR = 3.75 and 02.72, respectively; p < 0.001). ROC analysis revealed that SD _dn ≥12.8 was the optimal cut-off value for predicting NOAF during follow-up.

Conclusions

Short-term BPV was associated with NOAF during the 1-year follow-up in patients with STEMI. In addition, BPV was correlated significantly with atrial EMD. Herein, BPV was predicted to be an early predictor of NOAF in patients with STEMI.