What is the clinical evidence from this study?

Study design: Observational. Population: ST-segment elevation myocardial infarction (n=207). Intervention: Impaired coronary flow in the dominant coronary atrial branch vs. Normal coronary flow in the dominant coronary atrial branch. Primary outcome: Left atrial maximal volume at 6 months (mL/m2) (p=<0.001).

August 14, 2022Open Access

Effects of Atrial Ischemia on Left Atrial Remodeling in Patients with ST-Segment Elevation Myocardial Infarction

Key Result

Impaired coronary flow in the dominant coronary atrial branch in patients with STEMI was associated with significantly larger left atrial maximal volumes (26.9 vs 18.1 mL/m2) at 6 months.

Study Design

Type

Observational (n=207)

Blinding

Single-blind

Multicenter

Structured PICO

Does impaired coronary flow in the dominant coronary atrial branch lead to adverse left atrial remodeling in patients with STEMI?

Population

207 patients (mean age 62 years, 17.4% female) with ST-segment elevation myocardial infarction and culprit lesions in the right coronary or left circumflex artery, followed for 12 months.

Exposure

Impaired coronary flow in the dominant coronary atrial branch (CAB), defined as Thrombolysis In Myocardial Infarction (TIMI) flow grade < 3.

Comparator

Normal dominant CAB coronary flow (age- and sex-matched control group).

Outcome

Echocardiographic left atrial (LA) remodeling, including LA strain parameters and total atrial conduction time.surrogate

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.

Main Result

Absolute Event Rate: 26.9% vs 18.1%

p-value: p=<0.001

Limitations

Retrospective, observational study design with potential selection bias
Dominant CAB with flush ostial occlusion may have been overlooked during coronary angiography
No objective quantification of the extension of ischemia-induced atrial myocardial damage
Exact timing of changes in LA structure and function could not be determined
Preexisting atrial remodeling from previous myocardial infarction cannot be excluded

Abstract

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. RESULTS: , P < .001) and longer total atrial conduction time (150 ± 23 vs 124 ± 22 msec, P < .001) at 6 months, remaining unchanged at 12 months. 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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