Frequency of Complete Atrioventricular Block Complicating ST-Elevation Myocardial Infarction in Patients Undergoing...

Area of Science:

• Cardiology
• Interventional Cardiology
• Electrophysiology

Background:

• ST-segment elevation myocardial infarction (STEMI) is frequently complicated by conduction disturbances, notably complete atrioventricular block (CAVB).
• Historically, CAVB complicating STEMI was associated with high mortality, particularly before the widespread adoption of primary percutaneous coronary intervention (PCI).

Purpose of the Study:

• To determine the incidence and identify risk factors for CAVB in patients with STEMI undergoing primary PCI.
• To compare the outcomes of CAVB in the era of primary PCI with historical data from the thrombolytic era.

Main Methods:

• A retrospective analysis of 223 patients presenting with STEMI.
• Comparison of patient and procedural characteristics, as well as in-hospital outcomes, between patients with and without CAVB.
• Patients underwent primary PCI for reperfusion therapy.

Main Results:

• CAVB occurred in 4.6% of STEMI patients undergoing primary PCI (8 out of 223), with 6 cases linked to right coronary artery occlusion.
• Independent predictors for CAVB included diabetes mellitus, female gender, lower blood pressure, and inferior-lateral/lateral STEMI location.
• Ten patients (5.7%) required temporary pacing, and only one needed permanent pacing before discharge; no anterior STEMI patients developed CAVB.

Conclusions:

• The incidence of CAVB and associated in-hospital mortality in STEMI patients treated with primary PCI is lower than previously reported in the thrombolytic era.
• Faster restoration of blood flow in the infarct-related artery via primary PCI likely contributes to the reduced incidence and improved outcomes of CAVB.