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Long-term outcome in patients with inferior myocardial infarction and complete atrioventricular block
P Nicod1, E Gilpin, H Dittrich
1Division of Cardiology, University of California, San Diego Medical Center 92103-1990.
Insights
Patients with inferior myocardial infarction and complete heart block face higher in-hospital mortality but have similar 1-year outcomes compared to those without heart block. This study tracked 749 patients for a year post-discharge.
Area of Science:
- Cardiology
- Clinical Medicine
- Internal Medicine
Background:
- Inferior myocardial infarction (MI) with complete heart block (CHB) is associated with increased short-term mortality and multivessel coronary artery disease.
- Limited data exists on the long-term clinical outcomes for patients with inferior MI and CHB after hospital discharge.
Purpose of the Study:
- To compare the 1-year clinical outcomes of patients with inferior myocardial infarction who experienced complete heart block during hospitalization versus those who did not.
Main Methods:
- Retrospective analysis of 749 patients admitted with inferior MI across four centers.
- Patients were divided into two groups: Group 1 (no CHB) and Group 2 (CHB during hospitalization).
- Follow-up was conducted for 1 year post-hospital discharge, assessing mortality, reinfarction, and clinical characteristics.
Main Results:
- Group 2 patients were older, had more signs of left ventricular failure, and higher peak creatine kinase levels.
- In-hospital mortality was significantly higher in Group 2 (24.2%) compared to Group 1 (6.3%).
- At discharge and during the 1-year follow-up, no significant differences were observed in clinical status, left ventricular ejection fraction, complex ventricular arrhythmias, mortality rates, or reinfarction rates between the two groups.
Conclusions:
- While complete heart block in inferior myocardial infarction patients increases in-hospital mortality, it does not appear to negatively impact 1-year post-discharge outcomes.
- Long-term prognosis appears similar for inferior MI patients with or without complete heart block, suggesting that initial management and risk stratification are key.
Abstract:
Some studies have reported increased short-term mortality and higher incidence of multivessel coronary artery disease in patients with inferior myocardial infarction and complete heart block, but information is lacking on clinical outcome after hospital discharge. Therefore, data were obtained and analyzed in 749 patients who were admitted with inferior myocardial infarction to four different centers and followed up for 1 year. Six hundred fifty-four patients (Group 1) did not have complete heart block and 95 (Group 2) had complete heart block during their hospital stay (incidence rate 12.8%). Compared with Group 1, Group 2 patients were older (66 versus 61 years, p less than 0.01), more often had signs of left ventricular failure (p less than 0.001) and had higher peak creatine kinase values (1,840 versus 1,322 IU/liter, p less than 0.001). The in-hospital mortality rate was higher in Group 2 than in Group 1 (24.2 versus 6.3%, p less than 0.001). However, at discharge there was no difference between Group 1 and Group 2 in clinical characteristics, left ventricular ejection fraction (0.52 +/- 0.12 versus 0.52 +/- 0.11) or incidence of complex ventricular arrhythmias on ambulatory electrocardiographic monitoring. Furthermore, during the year after hospital discharge, patients in Groups 1 and 2 did not have significantly different mortality rates (6.4 versus 10.1%, p = NS). The incidence rate of reinfarction (4%) was the same in Groups 1 and 2. The incidence of coronary artery bypass surgery was slightly but not significantly higher in Group 1 compared with Group 2 (11 versus 4%).(ABSTRACT TRUNCATED AT 250 WORDS)