Key result
High-degree atrioventricular block was associated with higher unadjusted mortality compared to no HAVB (15.8% vs. 4.1%, p<0.001), but was not an independent predictor of in-hospital mortality.
Why the study?
High-degree atrioventricular block is a known complication of STEMI, but its prevalence and prognostic impact in a contemporary cohort needed to be determined.
Does high-degree atrioventricular block at admission independently predict in-hospital mortality in STEMI patients treated with urgent reperfusion?
Cohort (n=1,109)
No
Does high-degree atrioventricular block at admission independently predict in-hospital mortality in STEMI patients treated with urgent reperfusion?
High-degree AV block complicates approximately 9% of STEMI cases, particularly in older men with renal failure and right coronary artery culprits, and while associated with higher crude mortality, it is not an independent predictor of in-hospital death.
HAVB occurs in 9% of contemporary STEMI with worse in-hospital outcomes but is not independently prognostic; leaves open its causal role.
Background: High-degree atrioventricular block (HAVB) is a known complication of ST-segment elevation myocardial infarction (STEMI). We aimed to determine the prevalence and prognostic impact of HAVB in a contemporary cohort of STEMI. Methods: Data were collected from the DIAMANTE registry that included STEMI patients admitted to our cardiac intensive care unit treated with urgent reperfusion. We studied the clinical characteristics and evolution in patients with and without HAVB at admission. Results: From 1109 consecutive patients, HAVB was documented in 95 (8.6%). The right coronary artery was the culprit vessel in 84 patients with HAVB (88.4%). The independent predictors of HAVB were: male sex (OR 1.9, 95% CI 1.2–2.9), age (OR 1.03, 95% CI 1.01–1.05), involvement of right coronary artery (OR 12.4, 95% CI 7.6–20.2), and creatinine value (OR 1.5, 95% CI 1.1–2.0). A transient percutaneous pacemaker was used in 37 patients with HAVB (38.9%). Patients with HAVB had higher mortality that patients without HAVB (15.8% vs. 4.1%, p < 0.001); however, in multivariate analysis, HAVB was not an independent predictor of in-hospital mortality. Conclusions: HAVB was seen in 9% of STEMI patients and was particularly frequent in elderly males with renal failure. Patients with HAVB had a poor prognosis during hospitalization, but HAVB was not an independent predictor of in-hospital mortality.
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Velásquez‐Rodríguez et al. (2023) conducted a cohort in ST-segment elevation myocardial infarction (n=1,109). High-degree atrioventricular block (HAVB) vs. No HAVB was evaluated on In-hospital mortality (p=<0.001). High-degree atrioventricular block was associated with higher unadjusted mortality compared to no HAVB (15.8% vs. 4.1%, p<0.001), but was not an independent predictor of in-hospital mortality.
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