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Published on: May 28, 2019
Complete Heart Block Complicating ST-Segment Elevation Myocardial Infarction: Temporal Trends and Association With
Prakash Harikrishnan1, Tanush Gupta1, Chandrasekar Palaniswamy2
1New York Medical College, Valhalla, New York.
Insights
Complete heart block (CHB) incidence slightly increased in ST-segment elevation myocardial infarction (STEMI) patients, remaining linked to significantly higher mortality. Despite declining pacemaker use, in-hospital death rates for CHB patients did not change over a decade.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- Limited data exists on complete heart block (CHB) incidence and outcomes in ST-segment elevation myocardial infarction (STEMI) patients receiving modern treatments.
- Understanding CHB's impact in contemporary STEMI management is crucial.
Purpose of the Study:
- To determine the association between CHB and patient outcomes following STEMI.
- To examine temporal trends in CHB incidence and outcomes complicating STEMI.
Main Methods:
- Utilized the National Inpatient Sample database (2003-2012) for STEMI patients (≥18 years).
- Identified patients with concomitant CHB diagnosis.
- Employed multivariable logistic regression to analyze CHB's association with outcomes and temporal trends.
Main Results:
- CHB was present in 2.2% of 2,273,853 STEMI patients, with incidence rising slightly from 2.1% to 2.3% (2003-2012).
- STEMI patients with CHB exhibited higher in-hospital mortality (20.4% vs. 8.7%), independent of STEMI location, particularly in anterior STEMI.
- While permanent pacemaker implantation decreased, in-hospital mortality for CHB patients remained unchanged.
Conclusions:
- CHB incidence in STEMI has marginally increased but remains low.
- CHB continues to be associated with elevated in-hospital mortality in STEMI patients, even with prompt reperfusion.
- Risk-adjusted in-hospital mortality for STEMI patients with CHB showed no significant change during the study period.
Objectives:
The purpose of this study was to determine the association of complete heart block (CHB) with outcomes and to examine temporal trends in the incidence and outcomes of CHB complicating ST-segment elevation myocardial infarction (STEMI).
Background:
There are limited data available on the incidence and outcomes of CHB in STEMI patients who undergo contemporary management.
Methods:
We used the 2003 to 2012 National Inpatient Sample databases to identify all patients age ≥18 years hospitalized with STEMI. Patients with a concomitant diagnosis of CHB were then identified. Multivariable logistic regression was used to analyze the association of CHB with outcomes and to examine the temporal trends in incidence and outcomes of CHB complicating STEMI.
Results:
Of 2,273,853 patients with STEMI, 49,882 (2.2%) had CHB. The incidence of CHB increased from 2.1% in 2003 to 2.3% in 2012 (adjusted odds ratio [OR] per year: 1.02; 95% confidence interval [CI]: 1.02 to 1.03). STEMI patients with CHB had higher in-hospital mortality than those without CHB (20.4% vs. 8.7%; adjusted OR: 2.47; 95% CI: 2.41 to 2.53). The higher mortality associated with CHB was independent of the location of STEMI; however, the magnitude of this association was greatest in patients with anterior STEMI. In patients with CHB complicating STEMI, although permanent pacemaker implantation rates declined (adjusted OR per year: 0.96; 95% CI: 0.95 to 0.97), in-hospital mortality remained unchanged during the study period (adjusted OR per year: 1.00; 95% CI: 0.99 to 1.01).
Conclusions:
The incidence of CHB complicating STEMI has increased slightly over the last decade, although the absolute incidence remains quite low. CHB remains associated with higher in-hospital mortality in STEMI patients even in the current era of prompt reperfusion therapy. In patients with CHB complicating STEMI, there was no change in risk-adjusted in-hospital mortality during the study period.
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