High-grade atrioventricular block in acute coronary syndromes: insights from the Global Registry of Acute Coronary
Sheldon M Singh1, Gordon FitzGerald2, Andrew T Yan3
1Division of Cardiology, Department of Medicine, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
European Heart Journal
|September 11, 2014
Summary
High-grade atrioventricular block (HAVB) in acute coronary syndrome (ACS) patients is uncommon but carries a high risk of in-hospital death. Early interventions improve survival, though overall mortality remains a concern.
Area of Science:
- Cardiology
- Clinical Medicine
- Medical Research
Background:
- Prior studies linked high-grade atrioventricular block (HAVB) to in-hospital death in acute coronary syndrome (ACS).
- Limited data exists on HAVB incidence and outcomes in ACS patients under contemporary management.
Purpose of the Study:
- To determine the incidence of HAVB in ACS patients.
- To compare outcomes between ACS patients with and without HAVB.
- To identify factors associated with death in ACS patients with HAVB.
Main Methods:
- Analysis of 59,229 ACS patients from The Global Registry of Acute Coronary Events (GRACE) (1999-2007).
- Comparison of clinical characteristics, therapies, and outcomes for patients with and without HAVB.
- Statistical analysis to determine factors associated with in-hospital death in HAVB patients.
Main Results:
- 2.9% of ACS patients experienced HAVB; 22.7% of these died in-hospital (OR=4.2).
- HAVB-associated mortality varied by ACS type (STEMI, non-STEMI, unstable angina).
- Early PCI/fibrinolysis and presentation with HAVB improved survival; temporary pacemakers did not. HAVB rates decreased, but mortality did not.
Conclusions:
- HAVB is a low-incidence complication in ACS but remains associated with significant in-hospital mortality.
- While the incidence of HAVB is decreasing, its associated in-hospital death risk persists.
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