High-degree atrioventricular block complicating ST segment elevation myocardial infarction in the contemporary era
Vincent Auffret1, Aurélie Loirat1, Guillaume Leurent1
1CHU Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, France Université de Rennes 1, LTSI, Rennes, France INSERM, U1099, Rennes, France.
Insights
High-degree atrioventricular block (HAVB) in ST-segment elevation myocardial infarction (STEMI) is common but not an independent predictor of in-hospital death. Patients with HAVB face higher mortality, yet other factors significantly influence outcomes in modern STEMI care.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- High-degree atrioventricular block (HAVB) is a recognized complication of ST-segment elevation myocardial infarction (STEMI).
- Contemporary data on HAVB in STEMI patients undergoing modern treatments are limited.
- Historically, HAVB has been associated with adverse outcomes in STEMI.
Purpose of the Study:
- To determine the incidence, clinical correlates, and in-hospital outcomes of HAVB in STEMI.
- To compare outcomes between patients with HAVB on admission versus those developing it during hospitalization.
- To analyze the impact of HAVB in the current era of advanced STEMI management.
Main Methods:
- Analysis of a large prospective registry (ORBI) of STEMI patients from June 2006 to December 2013.
- Patients were categorized into three groups: no HAVB, HAVB on admission, and HAVB during hospitalization.
- Multivariable analysis was employed to assess independent predictors of in-hospital mortality.
Main Results:
- HAVB occurred in 3.5% of 6662 STEMI patients; 63.7% had HAVB on admission, 36.3% developed it during hospitalization.
- In-hospital mortality was higher for patients with HAVB on admission (18.1%) or within 24 hours (28.6%) compared to those without (4.5%).
- Multivariable analysis revealed HAVB was not an independent predictor of in-hospital mortality, unlike age, cardiac arrest, anterior STEMI, reperfusion therapy, cardiogenic shock, mechanical ventilation, or ventricular arrhythmias.
Conclusions:
- Patients with HAVB experienced higher mortality rates compared to those without.
- Despite higher crude mortality, HAVB is not an independent predictor of in-hospital mortality in contemporary STEMI management.
- Factors such as age, STEMI characteristics, and complications are more critical determinants of outcomes.
Background:
High-degree atrioventricular block (HAVB) is a common complication of ST segment elevation myocardial infarction (STEMI). HAVB in STEMI is historically considered as a marker of worse outcome but overall data about HAVB in the contemporary era of mechanical reperfusion and potent antiplatelet therapies are scarce.
Aim:
Analysing incidence, clinical correlates and impact on inhospital outcomes of HAVB in a large prospective registry (Observatoire Régional Breton sur l'Infarctus, ORBI) of modern management of STEMI with a special focus on potential differences between patients with HAVB on admission and those who developed HAVB during hospitalisation.
Methods:
All patients enrolled in ORBI between June 2006 and December 2013 were included in the present analysis and were divided into 3 groups: patients without HAVB at any time, patients with HAVB on admission and those who developed HAVB during hospitalisation.
Results:
A total of 6662 patients (age: 62.0 (52.0-74.0) years; male: 76.3%) were included in the present analysis. HAVB was documented in 3.5% of patients, present on admission in 63.7% of patients and occurring during hospitalisation in 36.3%. Patients with HAVB on admission or occurring during the first 24 h of hospitalisation had higher inhospital mortality rates (18.1% and 28.6%, respectively) than patients without (4.5%) or with HAVB occurring beyond the first 24 h of hospitalisation (8.0%). However by multivariable analysis, HAVB was not independently associated with inhospital mortality contrarily to age, presentation as cardiac arrest, anterior STEMI location, reperfusion therapy, cardiogenic shock, mechanical ventilation and occurrence of sustained ventricular tachyarrhythmias or mechanical complication.
Conclusions:
Patients with HAVB had a higher mortality rate than patients without. However HAVB is not an independent predictor of inhospital mortality.
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