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High-grade atrioventricular block in acute coronary syndromes: insights from the Global Registry of Acute Coronary Events.

Abstract：

BACKGROUND:While prior work has suggested that a high-grade atrioventricular block (HAVB) in the setting of an acute coronary syndrome (ACS) is associated with in-hospital death, limited information is available on the incidence of, and death associated with, HAVB in ACS patients receiving contemporary management. METHODS AND RESULTS:The incidence of HAVB was determined within The Global Registry of Acute Coronary Events (GRACE). The clinical characteristics, in-hospital therapies, and outcomes were compared between patients with and without HAVB. Factors associated with death in patients with HAVB were determined. A total of 59 229 patients with ACS between 1999 and 2007 were identified; 2.9% of patients had HAVB at any point during the index hospitalization; 22.7% of whom died in hospital [adjusted odds ratio (OR) = 4.2, 95% confidence interval (CI), 3.6-4.9, P < 0.001]. The association between HAVB and in-hospital death varied with type of ACS [OR: ST-segment elevation myocardial infarction (STEMI) = 3.0; non-STEMI = 6.4; unstable angina = 8.2, P for interaction < 0.001]. High-grade atrioventricular block present at the time of presentation to hospital (vs. occurring in-hospital) and early (<12 h) percutaneous coronary intervention or fibrinolysis (vs.>12 h or no intervention) were associated with improved in-hospital survival, whereas temporary pacemaker insertion was not. Patients with HAVB surviving to discharge had similar adjusted survival at 6 months compared with those without HAVB. A reduction in the rate of, but not in-hospital mortality associated with, HAVB was noted over the study period. CONCLUSION:Although the incidence of HAVB is low and decreasing, this complication continues to have a high risk of in-hospital death.

journal_name

Eur Heart J

journal_title

European heart journal

authors

Singh SM,FitzGerald G,Yan AT,Brieger D,Fox KA,López-Sendón J,Yan RT,Eagle KA,Steg PG,Budaj A,Goodman SG

doi

10.1093/eurheartj/ehu357

subject

Has Abstract

pub_date

2015-04-21 00:00:00

pages

976-83

issue

eissn

0195-668X

issn

1522-9645

pii

ehu357

journal_volume

pub_type

杂志文章,多中心研究

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High-grade atrioventricular block in acute coronary syndromes: insights from the Global Registry of Acute Coronary Events.