Key result
High 24-hour BP variability linked to ~275% higher 1-year new-onset AF risk in STEMI patients.
Why the study?
The association between 24-h blood pressure variability and atrial electromechanical delay in STEMI patients developing new-onset atrial fibrillation was unclear.
Does high 24-h blood pressure variability predict new-onset atrial fibrillation in patients with STEMI undergoing primary PCI?
Cohort (n=175)
Does high 24-h blood pressure variability predict new-onset atrial fibrillation in patients with STEMI undergoing primary PCI?
Short-term blood pressure variability is an independent predictor of new-onset atrial fibrillation and correlates with atrial electromechanical delay in patients with STEMI.
High BP variability may identify STEMI patients for closer AF monitoring; leaves open causal role and need for prospective trials.
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 (SDdn). Results: Based on the median of BPV index (SDdn) = 9.5 mm Hg of all participants, patients were stratified into low and high variability groups (SDdn: 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 SDdn and intra-left atrial and inter-atrial EMD (p < 0.001 and <0.01, respectively). Cox regression analysis revealed that SDdn 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 SDdn ≥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.
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Mahfouz et al. (2020) conducted a cohort in ST segment elevation myocardial infarction (STEMI) (n=175). High 24-h blood pressure variability vs. Low 24-h blood pressure variability was evaluated on New-onset atrial fibrillation (NOAF) (OR 3.75, p=<0.001). High 24-hour blood pressure variability was associated with increased new-onset atrial fibrillation at 1 year in STEMI patients compared to low variability (28.9% vs 3.5%; OR 3.75, p<0.001).
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