High-degree atrioventricular block complicating ST-segment elevation myocardial infarction in the era of primary
Uffe Jakob Ortved Gang1, Anders Hvelplund, Sune Pedersen
1Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark. dr.gang@dadlnet.dk
Insights
High-degree atrioventricular block (HAVB) occurred in 3.2% of ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (pPCI). Despite reduced incidence, HAVB remains a significant mortality predictor within 30 days post-STEMI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Research
Background:
- Primary percutaneous coronary intervention (pPCI) is the standard treatment for ST-segment elevation myocardial infarction (STEMI).
- The incidence and prognostic impact of high-degree atrioventricular block (HAVB) in the pPCI era require further investigation.
Purpose of the Study:
- To determine the incidence, predictors, and prognostic significance of HAVB in STEMI patients undergoing pPCI.
Main Methods:
- Retrospective analysis of 2073 STEMI patients treated with pPCI.
- Data sourced from hospital and Danish National Patient Registers.
- All-cause mortality as the primary endpoint, with a median follow-up of 2.9 years.
Main Results:
- HAVB was identified in 67 patients (3.2%), with 25 deaths.
- Predictors included right coronary artery occlusion, age >65, female gender, hypertension, and diabetes.
- HAVB significantly increased adjusted mortality (HR=3.14, P<0.001), primarily within 30 days post-STEMI.
Conclusions:
- The incidence of HAVB in STEMI patients treated with pPCI is lower than in the thrombolytic era.
- HAVB remains a critical prognostic marker in STEMI patients treated with pPCI.
- Mortality risk associated with HAVB is concentrated within the first 30 days; survivors have a similar prognosis to those without HAVB.
Aims:
Primary percutaneous coronary intervention (pPCI) has replaced thrombolysis as treatment-of-choice for ST-segment elevation myocardial infarction (STEMI). However, the incidence and prognostic significance of high-degree atrioventricular block (HAVB) in STEMI patients in the pPCI era has been only sparsely investigated. The objective of this study was to assess the incidence, predictors and prognostic significance of HAVB in STEMI patients treated with pPCI.
Methods And Results:
This study included 2073 STEMI patients treated with pPCI. The patients were identified through a hospital register and the Danish National Patient Register. Both registers were also used to establish the diagnosis of HAVB. All-cause mortality was the primary endpoint. During a median follow-up of 2.9 years [interquartile range (IQR) 1.8-4.0] 266 patients died. High-degree atrioventricular block was documented in 67 (3.2%) patients of whom 25 died. Significant independent predictors of HAVB included right coronary artery occlusion, age >65 years, female gender, hypertension, and diabetes. The adjusted mortality rate was significantly increased in patients with HAVB compared to patients without HAVB [hazard ratio = 3.14 (95% confidence interval 2.04-4.84), P< 0.001]. A landmark-analysis 30 days post-STEMI showed equal mortality rates in the two groups.
Conclusion:
The incidence of HAVB in STEMI patients treated with pPCI has been reduced compared with reports from the thrombolytic era. However, despite this improvement high-degree AV block remains a severe prognostic marker in the pPCI era. The mortality rate was only increased within the first 30 days. High-degree atrioventricular block patients who survived beyond this time-point thus had a prognosis equal to patients without HAVB.
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