High-degree atrioventricular block complicating ST-segment elevation myocardial infarction in the era of primary percutaneous coronary intervention

被引:85
作者
Gang, Uffe Jakob Ortved [1 ,2 ]
Hvelplund, Anders [1 ]
Pedersen, Sune [1 ]
Iversen, Allan [1 ]
Jons, Christian [1 ]
Abildstrom, Steen Zabell [3 ]
Haarbo, Jens [1 ]
Jensen, Jan Skov [1 ]
Thomsen, Poul Erik Bloch [1 ]
机构
[1] Gentofte Univ Hosp, Dept Cardiol, Copenhagen, Denmark
[2] Glostrup Univ Hosp, Dept Internal Med, DK-2600 Glostrup, Denmark
[3] Bispebjerg Hosp, Dept Cardiol, Copenhagen, Denmark
来源
EUROPACE | 2012年 / 14卷 / 11期
关键词
Atrioventricular block; Myocardial infarction; Primary percutaneous intervention; COMPLETE HEART-BLOCK; LONG-TERM PROGNOSIS; ACUTE INFERIOR; THROMBOLYTIC THERAPY; HOSPITAL DEATH; PERSPECTIVE; FREQUENCY; OUTCOMES;
D O I
10.1093/europace/eus161
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims Primary percutaneous coronary intervention (pPCI) has replaced thrombolysis as treatment-of-choice for ST-segment elevation myocardial infarction (STEMI). However, the incidence and prognostic significance of high-degree atrioventricular block (HAVB) in STEMI patients in the pPCI era has been only sparsely investigated. The objective of this study was to assess the incidence, predictors and prognostic significance of HAVB in STEMI patients treated with pPCI. Methods and results This study included 2073 STEMI patients treated with pPCI. The patients were identified through a hospital register and the Danish National Patient Register. Both registers were also used to establish the diagnosis of HAVB. All-cause mortality was the primary endpoint. During a median follow-up of 2.9 years [interquartile range (IQR) 1.8-4.0] 266 patients died. High-degree atrioventricular block was documented in 67 (3.2%) patients of whom 25 died. Significant independent predictors of HAVB included right coronary artery occlusion, age >65 years, female gender, hypertension, and diabetes. The adjusted mortality rate was significantly increased in patients with HAVB compared to patients without HAVB [hazard ratio =3.14 (95% confidence interval 2.04-4.84), P < 0.001]. A landmark-analysis 30 days post-STEMI showed equal mortality rates in the two groups. Conclusion The incidence of HAVB in STEMI patients treated with pPCI has been reduced compared with reports from the thrombolytic era. However, despite this improvement high-degree AV block remains a severe prognostic marker in the pPCI era. The mortality rate was only increased within the first 30 days. High-degree atrioventricular block patients who survived beyond this time-point thus had a prognosis equal to patients without HAVB.
引用
收藏
页码:1639 / 1645
页数:7
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