High-grade atrioventricular block in acute coronary syndrome: Portuguese experience
Helder Santos1, Mariana Santos1, Inês Almeida1
1Serviço de Cardiologia, Centro Hospitalar Barreiro-Montijo EPE, Barreiro, Portugal.
Insights
High-grade atrioventricular block (HAVB) in acute coronary syndrome (ACS) patients is linked to worse outcomes. This complication is associated with increased in-hospital events and higher mortality rates at one year.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- High-grade atrioventricular block (HAVB) is a serious complication of acute coronary syndrome (ACS).
- Prompt management of HAVB in ACS is critical for reperfusion and rhythm stabilization.
- Understanding HAVB's impact in ACS is vital for improving patient outcomes.
Purpose of the Study:
- To analyze the incidence, clinical characteristics, and management of HAVB in ACS patients.
- To investigate complications, in-hospital mortality, and follow-up outcomes of HAVB in ACS.
- To identify predictors of HAVB in the context of ACS.
Main Methods:
- A multicenter retrospective study utilizing the Portuguese National Registry of ACS.
- Inclusion of 32,157 patients admitted for ACS between 2010 and 2020.
- Comparison of patients with and without HAVB, employing logistic regression to identify predictors.
Main Results:
- HAVB patients were older, more frequently female, and had higher rates of prior stroke and neoplasia.
- HAVB was associated with ST-elevation myocardial infarction, syncope, higher Killip-Kimball class, and multivessel disease.
- HAVB patients experienced more major adverse cardiac events, including heart failure, cardiogenic shock, and in-hospital death, with increased 1-year all-cause mortality.
Conclusions:
- Patients with HAVB complicating ACS face a poorer prognosis during hospitalization.
- HAVB in ACS is associated with significantly worse short-term follow-up outcomes.
- Real-world data confirms the adverse impact of HAVB on ACS patient prognosis.
Background:
The high-grade atrioventricular block (HAVB) occurrence in acute coronary syndrome (ACS) is a potentially life-threatening complication, that demands a rapid and efficient response regarding reperfusion time and rhythm stabilization. This study aimed to analyse the rate, clinical features, therapeutic approach, complications, in-hospital mortality and follow-up of HAVB in the setting of ACS.
Methods:
Multicenter retrospective study based on the Acute Coronary Syndrome Portuguese National Registry, including 32157 patients admitted for ACS between 1/10/2010-3/05/2020, classified according to the presence or absence of HAVB during the hospitalization for ACS. Comparison between the two groups was performed. Logistic regression was accomplished to assess predictors of HAVB in ACS patients.
Results:
Patients with HAVB were older, and had higher rates of females, history of stroke and neoplasia. HAVB patients presented more frequently ST-segment elevation myocardial infarction, syncope as a major symptom, higher Killip-Kimball class and multivessel disease. Furthermore, HAVB patients had more major adverse cardiac events during the hospitalization for ACS, namely heart failure complication, cardiogenic shock complication, new-onset of atrial fibrillation, ACS mechanical complication, sustained ventricular tachycardia, cardiac arrest, stroke complication and in-hospital death. Logistic regression revealed that female gender, age ≥ 75 years old, heart rate < 60 and Killip-Kimball class > I were predictors of HAVB in ACS patients. Also, HAVB patients presented higher rates of all-causes of death at 1-year follow-up (p = 0.011).
Conclusions:
Using real-life data, patients with HAVB in the setting of ACS had a worse prognosis during hospitalization and in the short-term follow-up period.
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