Korean Circ J.  2016 May;46(3):315-323. 10.4070/kcj.2016.46.3.315.

Differential Clinical Implications of High-Degree Atrioventricular Block Complicating ST-Segment Elevation Myocardial Infarction according to the Location of Infarction in the Era of Primary Percutaneous Coronary Intervention

• Kim KH
• Jeong MH
• Ahn Y
• Kim YJ
• Cho MC
• Kim W
• Other Korea Acute Myocardial Infarction Registry Investigators

• KMID: 2344444
• DOI: http://doi.org/10.4070/kcj.2016.46.3.315

Abstract

BACKGROUND AND OBJECTIVES
The clinical implication of high-degree (second- and third-degree) atrioventricular block (HAVB) complicating ST-segment elevation myocardial infarction (STEMI) is ripe for investigation in this era of primary percutaneous coronary intervention (PCI). We sought to address the incidence, predictors and prognosis of HAVB according to the location of infarct in STEMI patients treated with primary PCI.
SUBJECTS AND METHODS
A total of 16536 STEMI patients (anterior infarction: n=9354, inferior infarction: n=7692) treated with primary PCI were enrolled from a multicenter registry. We compared in-hospital mortality between patients with HAVB and those without HAVB with anterior or inferior infarction, separately. Multivariate analyses were performed to unearth predictors of HAVB and to identify whether HAVB is independently associated with in-hospital mortality.
RESULTS
STEMI patients with HAVB showed higher in-hospital mortality than those without HAVB in both anterior (hazard ratio [HR]=9.821, 95% confidence interval [CI]: 4.946-19.503, p<0.001) and inferior infarction (HR=2.819, 95% CI: 2.076-3.827, p<0.001). In multivariate analyses, HAVB was associated with increased in-hospital mortality in anterior myocardial infarction (HR=19.264, 95% CI: 5.804-63.936, p<0.001). However, HAVB in inferior infarction was not an independent predictor of increased in-hospital mortality (HR=1.014, 95% CI: 0.547-1.985, p=0.901).
CONCLUSION
In this era of primary PCI, the prognostic impact of HAVB is different according to the location of infarction. Because of recent improvements in reperfusion strategy, the negative prognostic impact of HAVB in inferior STEMI is no longer prominent.

Keyword

Atrioventricular block; Myocardial infarction; Primary percutaneous coronary intervention; In-hospital mortality

MeSH Terms

Atrioventricular Block*
Hospital Mortality
Humans
Incidence
Infarction*
Multivariate Analysis
Myocardial Infarction*
Percutaneous Coronary Intervention*
Prognosis
Reperfusion

Figure

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  Fig. 1 Comparison of in-hospital mortality between patients with and without HAVB in anterior and inferior STEMI. HAVB: high-degree atrioventricular block, STEMI: ST-segment elevation myocardial infarction, HR: hazard ratio.

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  Fig. 2 Comparison of cumulative long-term all-cause survival between patients with and without HAVB in anterior (A) and inferior (B) STEMI among in-hospital survivors. HAVB: high-degree atrioventricular block, STEMI: ST-segment elevation myocardial infarction, HR: hazard ratio, CI: confidence interval.

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  Fig. 3 Multivariate logistic regression analysis for in-hospital mortality in patients with anterior STEMI. STEMI: ST-segment elevation myocardial infarction, HAVB: hgh-degree atrioventricular block, LVEF: left ventricular ejection fraction, TIMI: thrombolysis in myocardial infarction, SBP: systolic blood pressure, HR: hazard ratio, CI: confidence interval.

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  Fig. 4 Multivariate logistic regression analysis for in-hospital mortality in patients with inferior STEMI. STEMI: ST-segment elevation myocardial infarction, HAVB: high-degree atrioventricular block, LVEF: left ventricular ejection fraction, TIMI: thrombolysis in myocardial infarction, SBP: systolic blood pressure, HR: hazard ratio, CI: confidence interval.

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