Complete atrioventricular block in acute coronary syndrome: prevalence, characterisation and implication on outcome
Silvia Aguiar Rosa1, Ana Teresa Timóteo1, Lurdes Ferreira1
1Cardiology Department, Santa Marta Hospital, Portugal.
Insights
Complete atrioventricular block in acute coronary syndrome patients significantly increases in-hospital mortality, particularly from cardiogenic shock and arrhythmias. However, one-year survival rates remain similar between groups.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- Acute coronary syndrome (ACS) is a leading cause of cardiovascular mortality.
- Complete atrioventricular block (CAVB) is a serious complication that can arise during ACS.
- Understanding the impact of CAVB on ACS patient outcomes is crucial for clinical management.
Purpose of the Study:
- To characterize patients with ACS and CAVB.
- To evaluate the clinical, electrocardiographic, and echocardiographic features of these patients.
- To assess the impact of CAVB on short-term and long-term outcomes in ACS.
Main Methods:
- Retrospective analysis of 4799 ACS patients.
- Division into two groups: with (Group 1) and without (Group 2) CAVB.
- Comparison of clinical characteristics, in-hospital events, and one-year follow-up data.
Main Results:
- 1.9% of ACS patients presented with CAVB.
- CAVB patients had lower blood pressure, higher Killip class, and more syncope.
- CAVB was associated with higher rates of STEMI, RVMI, cardiogenic shock, ventricular arrhythmias, and hospital mortality.
Conclusions:
- Complete atrioventricular block is an independent predictor of worse in-hospital outcomes in ACS.
- Higher incidence of cardiogenic shock, ventricular arrhythmias, and death observed in patients with CAVB.
- No significant difference in one-year mortality between groups, suggesting short-term impact.
Purpose:
The aim was to characterise acute coronary syndrome patients with complete atrioventricular block and to assess the effect on outcome.
Methods:
Patients admitted with acute coronary syndrome were divided according to the presence of complete atrioventricular block: group 1, with complete atrioventricular block; group 2, without complete atrioventricular block. Clinical, electrocardiographic and echocardiographic characteristics and prognosis during one year follow-up were compared between the groups.
Results:
Among 4799 acute coronary syndrome patients admitted during the study period, 91 (1.9%) presented with complete atrioventricular block. At presentation, group 1 patients presented with lower systolic blood pressure, higher Killip class and incidence of syncope. In group 1, 86.8% presented with ST-segment elevation myocardial infarction (STEMI), and inferior STEMI was verified in 79.1% of patients in group 1 compared with 21.9% in group 2 ( P<0.001). Right ventricular myocardial infarction was more frequent in group 1 (3.3% vs. 0.2%; P<0.001). Among patients who underwent fibrinolysis complete atrioventricular block was observed in 7.3% in contrast to 2.5% in patients submitted to primary percutaneous coronary intervention ( P<0.001). During hospitalisation group 1 had worse outcomes, with a higher incidence of cardiogenic shock (33.0% vs. 4.5%; P<0.001), ventricular arrhythmias (17.6% vs. 3.6%; P<0.001) and the need for invasive mechanical ventilation (25.3% vs. 5.1%; P<0.001). After a propensity score analysis, in a multivariate regression model, complete atrioventricular block was an independent predictor of hospital mortality (odds ratio 3.671; P=0.045). There was no significant difference in mortality at one-year follow-up between the study groups.
Conclusion:
Complete atrioventricular block conferred a worse outcome during hospitalisation, including a higher incidence of cardiogenic shock, ventricular arrhythmias and death.
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