Acute atrial infarction: a relatively neglected and under-recognized entity in clinical practice.

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Herz Pub Date : 2024-09-24 DOI:10.1007/s00059-024-05272-z

Chengye Di, Haijiang Wang, Mingming Wang, Qun Wang, Yanxi Wu, Longyu Li, Yan Zhang, Wenhua Lin

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Abstract

Background: Electrocardiograms (ECGs) and angiographic features indicative of acute atrial infarction (AAI) often go unnoticed and are under-recognized in clinical practice.

Methods: In this retrospective observational study, we analyzed the data of 3981 out of 9803 patients (40.61%) who were referred to our hospital for angiography and/or percutaneous coronary intervention due to acute coronary syndrome (ACS). These patients were diagnosed with acute ST segment elevation myocardial infarction (AMI) affecting the inferior, posterior, and/or right ventricular regions.

Results: Of the 3981 patients, 270 (6.78%) had involvement of the main coronary atrial branch meeting the angiographic criteria for AAI. Among the 270 patients identified, the right coronary artery was diagnosed as the infarct-related artery (IRA) in 187 patients (group R), while the left circumflex artery was the IRA in 83 patients (group L). The incidence of PR-segment deviation was similar between the two groups (65.2% in group R vs. 66.3% in group L, p = 0.870), as was occurrence of atrial tachyarrhythmia (67.4% vs. 55.4%, p = 0.059). The prevalence of P wave morphology abnormalities (29.9% vs. 49.4%, p = 0.005) and sinus bradycardia or arrest (25.1% vs. 66.3%, p < 0.001) was significantly lower in Group R than in Group L.

Conclusion: Acute atrial infarction represents a distinct yet frequently overlooked clinical entity. Clinicians should consider the potential for atrial arrhythmias, thromboembolism, hemodynamic instability, and atrial rupture when diagnosing AAI.

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急性心房梗塞：临床实践中一个相对被忽视和认识不足的实体。

背景：心电图（ECG）和血管造影特征表明急性心房梗死（AAI），但在临床实践中往往被忽视和认识不足：在这项回顾性观察研究中，我们分析了因急性冠状动脉综合征（ACS）转诊至我院接受血管造影术和/或经皮冠状动脉介入治疗的 9803 名患者中的 3981 名患者（占 40.61%）的数据。这些患者被诊断为急性ST段抬高型心肌梗死（AMI），累及下心室、后心室和/或右心室区域：在 3981 例患者中，有 270 例（6.78%）患者的主要冠状动脉心房分支受累，符合 AAI 的血管造影标准。在已确定的 270 名患者中，187 名患者（R 组）的右冠状动脉被诊断为梗死相关动脉（IRA），83 名患者（L 组）的左侧环状动脉被诊断为 IRA。两组 PR 节段偏离的发生率相似（R 组 65.2% 对 L 组 66.3%，P = 0.870），房性快速性心律失常的发生率也相似（67.4% 对 55.4%，P = 0.059）。P 波形态异常（29.9% 对 49.4%，p = 0.005）和窦性心动过缓或停滞（25.1% 对 66.3%，p = 0.005）的发生率与急性心房梗塞的发生率相同：急性心房梗死是一种独特但经常被忽视的临床症状。临床医生在诊断 AAI 时应考虑房性心律失常、血栓栓塞、血流动力学不稳定和心房破裂的可能性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Herz 医学-心血管系统

CiteScore

3.00

自引率

5.90%

发文量

审稿时长

4-8 weeks

期刊介绍： Herz is the high-level journal for further education for all physicians interested in cardiology. The individual issues of the journal each deal with specific topics and comprise review articles in English and German written by competent and esteemed authors. They provide up-to-date and comprehensive information concerning the speciality dealt with in the issue. Due to the fact that all relevant aspects of the pertinent topic of an issue are considered, an overview of the current status and progress in cardiology is presented. Reviews and original articles round off the spectrum of information provided.