Factors associated with temporary pacing insertion in patients with inferior ST-segment elevation myocardial
Tomonobu Yanase1, Kenichi Sakakura1, Hiroyuki Jinnouchi1
1Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Shimotsuke, Japan.
Insights
High-degree atrioventricular block (HAVB) and larger thrombus burden predict the need for temporary pacing in inferior ST-elevation myocardial infarction (STEMI) patients. Statin use was associated with lower temporary pacing needs.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- High-degree atrioventricular block (HAVB) is a known prognostic factor in inferior ST-segment elevation myocardial infarction (STEMI).
- Limited data exists on factors predicting the need for temporary pacing (TP) in these patients.
Purpose of the Study:
- To identify clinical factors associated with the requirement for temporary pacing (TP) in patients experiencing inferior STEMI.
Main Methods:
- Retrospective analysis of 232 inferior STEMI patients.
- Patients were categorized into temporary pacing (TP) and non-TP groups.
- Multivariate logistic regression was employed to identify associated factors.
Main Results:
- Right ventricular (RV) infarction was more frequent in the TP group (19.6%) versus non-TP (7.5%).
- Statin use at admission (OR 0.230), HAVB at admission (OR 9.950), and TIMI-thrombus grade ≥3 (OR 10.762) were significantly associated with TP.
- In-hospital death and long-term major adverse cardiovascular events (MACE) did not differ between groups.
Conclusions:
- Statin use, HAVB, and high thrombus burden are key predictors for TP in inferior STEMI.
- Despite higher RV infarction rates in the TP group, outcomes regarding mortality and MACE were similar.
Background:
High-degree atrioventricular block (HAVB) is a prognostic factor for survival in patients with inferior ST-segment elevation myocardial infarction (STEMI). However, there is little information about factors associated with temporary pacing (TP). The aim of this study was to find factors associated with TP in patients with inferior STEMI.
Methods:
We included 232 inferior STEMI patients, and divided those into the TP group (n = 46) and the non-TP group (n = 186). Factors associated with TP were retrospectively investigated using multivariate logistic regression model.
Results:
The incidence of right ventricular (RV) infarction was significantly higher in the TP group (19.6%) than in the non-TP group (7.5%) (p = 0.024), but the incidence of in-hospital death was similar between the 2 groups (4.3% vs. 4.8%, p = 1.000). Long-term major adverse cardiovascular events (MACE), which were defined as a composite of all-cause death, non-fatal myocardial infarction (MI), target vessel revascularization (TVR) and readmission for heart failure, were not different between the 2 groups (p = 0.100). In the multivariate logistic regression analysis, statin at admission [odds ratio (OR) 0.230, 95% confidence interval (CI) 0.062-0.860, p = 0.029], HAVB at admission (OR 9.950, 95% CI 4.099-24.152, p<0.001), and TIMI-thrombus grade ≥3 (OR 10.762, 95% CI 1.385-83.635, p = 0.023) were significantly associated with TP.
Conclusion:
Statin at admission, HAVB at admission, and TIMI-thrombus grade ≥3 were associated with TP in patients with inferior STEMI. Although the patients with TP had the higher incidence of RV infarction, the incidence of in-hospital death and long-term MACE was not different between patients with TP and those without.
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