Ostio-proximal/mid right coronary artery occlusion did not significantly differ from distal occlusion in complete heart block recovery rates (88.71% vs 94.74%, p=0.48) after primary PCI.
Observational (n=100)
No
Does the site of RCA occlusion (ostio-proximal/mid vs distal) predict the rate and duration of complete heart block recovery in patients with acute inferior wall STEMI undergoing primary PCI?
The angiographic site of right coronary artery occlusion does not independently predict the rate or duration of complete heart block recovery after primary PCI in acute inferior wall STEMI, supporting expectant management rather than early permanent pacing based solely on lesion location.
Tasa de eventos absoluta: 88.71% vs 94.74%
valor p: p=0.48
Complete heart block (CHB) complicates a significant fraction of acute inferior wall ST-elevation myocardial infarctions (IW-STEMI) and is associated with high morbidity. Relationship between right coronary artery (RCA) occlusion site and CHB recovery remains incompletely characterised in the primary percutaneous coronary intervention (PCI) era. The objective of this study was to evaluate whether the site of RCA occlusion (ostio-proximal/mid versus distal) independently predicts the rate and duration of CHB recovery following primary PCI in acute IW-STEMI. This prospective observational study enrolled 100 patients with acute IW-STEMI with CHB who underwent primary PCI at a tertiary care centre in India. Patients were divided into Group 1 (ostio-proximal/mid RCA occlusion, n=62) and Group 2 (distal RCA occlusion, n=38). In-hospital serial electrocardiogram monitoring was performed till recovery/permanent pacing. The overall CHB recovery rate was 91%, with no significant difference between Group 1 (88.71%) and Group 2 (94.74%, p=0.48). Median recovery time was 12 hours in both groups (p=0.21). Independent predictors of reduced recovery included wide complex escape rhythm and associated right ventricular myocardial infarction. Multivariate analysis identified wide QRS pattern, higher baseline creatinine and development of acute kidney injury and heart failure as independent factors delaying CHB recovery in this critical patient subset. Angiographic site of RCA occlusion does not independently predict CHB recovery after primary PCI. Prompt revascularisation, metabolic status, and haemodynamic stability are key determinants of conduction recovery, supporting an expectant management strategy with serial electrocardiogram monitoring rather than early permanent pacing based solely on lesion location.
Gulati et al. (Fri,) conducted a observational in Acute inferior wall ST-elevation myocardial infarction with complete heart block (n=100). Ostio-proximal/mid RCA occlusion vs. Distal RCA occlusion was evaluated on Rate of CHB recovery (p=0.48). Ostio-proximal/mid right coronary artery occlusion did not significantly differ from distal occlusion in complete heart block recovery rates (88.71% vs 94.74%, p=0.48) after primary PCI.