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Clinical impact of complete atrioventricular block in patients with ST-segment elevation myocardial infarction

Yosuke Kawamura1, Hiroaki Yokoyama1, Kazutaka Kitayama1

  • 1Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.

Clinical Cardiology
|November 12, 2020
PubMed

Insights

Complete atrioventricular block (CAVB) is a rare but serious complication following ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). CAVB independently predicts worse outcomes, particularly in anterior STEMI patients, highlighting its prognostic significance.

Area of Science:

  • Cardiology
  • Internal Medicine
  • Clinical Research

Background:

  • Complete atrioventricular block (CAVB) is a known complication of ST-segment elevation myocardial infarction (STEMI).
  • The prognostic impact of CAVB in STEMI patients undergoing primary percutaneous coronary intervention (PCI) remains incompletely understood.
  • Previous data on CAVB and STEMI outcomes were primarily from the thrombolytic era.

Purpose of the Study:

  • To evaluate the clinical impact and prognostic significance of CAVB in STEMI patients treated with primary PCI.
  • To compare outcomes between anterior and nonanterior STEMI patients with and without CAVB.
  • To identify CAVB as an independent predictor of mortality and major adverse cardiocerebrovascular events (MACCE) in the primary PCI era.

Main Methods:

  • A consecutive cohort of 1295 STEMI patients undergoing primary PCI within 24 hours of symptom onset was analyzed.
  • Patients were stratified into anterior STEMI (n=640) and nonanterior STEMI (n=655) groups.
  • Outcomes, including all-cause death and MACCE, were assessed over a median follow-up of 3.8 years. CAVB development was recorded.

Main Results:

  • CAVB occurred in 6.3% of patients, with a significantly lower incidence in anterior STEMI (1.7%) versus nonanterior STEMI (10.7%).
  • Anterior STEMI patients with CAVB exhibited markedly higher rates of all-cause death (82% vs. 20%) and MACCE (82% vs. 25%) compared to those without CAVB.
  • While nonanterior STEMI patients with CAVB had increased all-cause mortality (30% vs. 18%), MACCE rates were similar to those without CAVB (24% vs. 19%).
  • Multivariate analysis identified CAVB as an independent predictor of mortality and MACCE in anterior STEMI, but not in nonanterior STEMI.

Conclusions:

  • Complete atrioventricular block is infrequent in anterior STEMI but carries a poor prognosis, even with modern primary PCI treatment.
  • CAVB is an independent predictor of adverse outcomes in anterior STEMI patients undergoing primary PCI.
  • The prognostic implications of CAVB differ based on infarct location in the primary PCI era.

Keywords:
ST-segment elevation myocardial infarctioncomplete atrioventricular blockpercutaneous coronary intervention

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