First-degree atrioventricular block in patients with stable coronary artery disease was associated with an increased risk of heart failure or cardiovascular death (HR 1.61; 95% CI 1.02-2.54; P=0.04).
Cohort (n=938)
Is first-degree atrioventricular block associated with heart failure and mortality in patients with stable coronary artery disease?
In patients with stable coronary artery disease, first-degree AV block is not a benign finding and is independently associated with increased risks of heart failure hospitalization and death.
Effect estimate: HR 1.61 (95% CI 1.02-2.54)
p-value: p=0.04
AIMS: First-degree atrioventricular block (AVB) has traditionally been considered a benign electrocardiographic finding in healthy individuals. However, the clinical significance of first-degree AVB has not been evaluated in patients with stable coronary heart disease. We investigated whether first-degree AVB is associated with heart failure (HF) and mortality in a prospective cohort study of outpatients with stable coronary artery disease (CAD). METHODS AND RESULTS: We measured the P-R interval in 938 patients with stable CAD and classified them into those with (P-R interval ≥ 220 ms) and without (P-R interval <220 ms) first-degree AVB. Hazard ratios (HRs) and 95% confidence intervals were calculated for HF hospitalization and all-cause mortality. During 5 years of follow-up, there were 123 hospitalizations for HF and 285 deaths. Compared with patients who had normal atrioventricular conduction, those with first-degree AVB were at increased risk for HF hospitalization (age-adjusted HR 2.33: 95% CI 1.49-3.65; P= 0.0002), mortality age-adjusted HR 1.58; 95% CI (1.13-2.20); P = 0.008, cardiovascular (CV) mortality age-adjusted HR 2.33; 95% CI (1.28-4.22); P= 0.005, and the combined endpoint of HF hospitalization or CV mortality (age-adjusted HR 2.43: 95% CI 1.64-3.61; P ≤ 0.0001). These associations persisted after multivariable adjustment for heart rate, medication use, ischaemic burden, and QRS duration. Adjustment for left ventricular systolic and diastolic function partially attenuated the effect, but first-degree AVB remained associated with the combined endpoint of HF or CV death (HR 1.61, CI 1.02-2.54; P= 0.04). CONCLUSION: In a large cohort of patients with stable coronary artery disease, first-degree AVB is associated with HF and death.
Crisel et al. (Mon,) conducted a cohort in Stable coronary artery disease (n=938). First-degree atrioventricular block (P-R interval ≥ 220 ms) vs. Normal atrioventricular conduction (P-R interval <220 ms) was evaluated on Combined endpoint of heart failure hospitalization or cardiovascular mortality (HR 1.61, 95% CI 1.02-2.54, p=0.04). First-degree atrioventricular block in patients with stable coronary artery disease was associated with an increased risk of heart failure or cardiovascular death (HR 1.61; 95% CI 1.02-2.54; P=0.04).