Prevalence, associated factors, and prognostic value of P wave abnormality in patients with coronary artery disease

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P-wave terminal force in V1 (PTFV1) on electrocardiography is an easily available and cost-effective surrogate marker reflecting myocardial electrical and structural remodeling. An abnormal PTFV1 was recently suggested to be a reliable predictor of adverse cardiovascular events, whereas its performance in the setting of coronary artery disease (CAD) remains unknown. We retrospectively investigated 3,147 patients with CAD who underwent percutaneous coronary intervention at our institution. Abnormal PTFV1 was defined as PTFV1 >0.04 mm∙s. The primary outcome was a composite of cardiac death and heart failure hospitalization. The Cox proportional hazard models were constructed to investigate the association between PTFV1 and clinical outcome. Among the study population, 592 (18.8%) patients had abnormal PTFV1. Patients with abnormal PTFV1 had worse atherosclerotic and cardiovascular profiles, higher concentrations of brain natriuretic peptide and C-reactive protein, and more advanced CAD than those with normal PTFV1 (p<0.05). The abnormal PTFV1 group had more pronounced left ventricular and atrial remodeling than normal PTFV1 group (p<0.05), but the association between left atrial size and PTFV1 was not significant after multivariable adjustment (p=0.355). During a median follow-up of 5.2 years, patients with abnormal PTFV1 more frequently experienced the primary outcome than those with normal PTFV1 (log-rank p<0.001). Abnormal PTFV1 carried a significant risk for the primary outcome independent of baseline characteristics, biomarkers, and angiographic features (adjusted hazard ratio 2.38, p<0.001). In patients with CAD who undergo percutaneous coronary intervention, abnormal PTFV1 is a robust and independent risk factor for adverse cardiovascular outcomes. • Among patients with coronary artery disease (CAD), 18.8% had abnormal P-wave terminal force in V1 (PTFV1), accompanied by more advanced left ventricular/atrial remodeling and a greater burden of CAD than those with normal PTFV1. • Abnormal PTFV1 was an independent risk factor for adverse cardiovascular outcomes including cardiac mortality and heart failure hospitalization, and had the incremental prognostic value above the atherosclerotic/cardiac profiles and the severity of CAD. • The independent and robust association between PTFV1 and long-term adverse cardiovascular outcomes could aid in early, easily available, and cost-effective risk stratification after coronary artery revascularization in patients with CAD.

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