Why the study?
Flow impairment in the dominant coronary atrial branch may affect large areas of left atrial myocardium, but its association with adverse left atrial remodeling after STEMI was unconfirmed.
Does impaired coronary flow in the dominant coronary atrial branch lead to adverse left atrial remodeling in patients with STEMI?
Observational (n=207)
Single-blind
No
Does impaired coronary flow in the dominant coronary atrial branch lead to adverse left atrial remodeling in patients with STEMI?
Atrial ischemia resulting from impaired coronary flow in the dominant coronary atrial branch during STEMI is associated with early and sustained adverse left atrial anatomic and functional remodeling.
May flag higher LA remodeling risk post-STEMI; leaves open whether targeted flow restoration improves outcomes.
BACKGROUND: Adverse left atrial (LA) remodeling after ST-segment elevation myocardial infarction (STEMI) has been associated with poor prognosis. Flow impairment in the dominant coronary atrial branch (CAB) may affect large areas of LA myocardium, potentially leading to adverse LA remodeling during follow-up. The aim of this study was to assess echocardiographic LA remodeling in patients with STEMI with impaired coronary flow in the dominant CAB. METHODS: Of 897 patients with STEMI, 69 patients (mean age, 62 ± 11 years; 83% men) with impaired coronary flow in the dominant CAB (defined as Thrombolysis In Myocardial Infarction flow grade < 3) were retrospectively compared with an age- and sex-matched control group of 138 patients with normal dominant CAB coronary flow. However, all LA strain parameters were significantly lower from baseline (reservoir, 20.3 ± 10.1% vs 27.1 ± 14.5% [P < .001]; conduit, 9.1 ± 5.6% vs 12.8 ± 8% [P < .001]; booster, 9.1 ± 5.6% vs 12.8 ± 8% [P < .001]), these differences being sustained at 6- and 12-month follow-up. CONCLUSIONS: Atrial ischemia resulting from impaired coronary flow in the dominant CAB in patients with STEMI is associated with LA adverse anatomic and functional remodeling. Reduced LA strain preceded LA anatomic remodeling in early phases after STEMI.
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Montero-Cabezas et al. (2022) conducted an observational in ST-segment elevation myocardial infarction (n=207). Impaired coronary flow in the dominant coronary atrial branch vs. Normal coronary flow in the dominant coronary atrial branch was evaluated on Left atrial maximal volume at 6 months (mL/m2) (p=<0.001).
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