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Management and outcome of patients with acute myocardial infarction presenting with pacemaker rhythm.

Abstract：

BACKGROUND:Diagnosis of acute myocardial infarction (MI) is challenging in pacemaker patients. Little is known about this patient group. METHODS:Patients with MI enrolled in the Swiss national AMIS Plus registry between January 2005 and December 2015 were analyzed. All patients with either paced ventricular rhythm or sinus rhythm with intrinsic ventricular conduction (IVC) were included in this study. Outcomes using crude data and propensity score matching were compared between patients with pacemaker rhythm and patients with IVC. The primary endpoint was in-hospital death. RESULTS:Data from 300 patients with paced rhythm and 27,595 with IVC were analyzed. Patients with pacemaker rhythm were older (78.2y vs 65.4y; p<0.001), had more comorbidities (Charlson Index (CCI)>1: 54.0% vs 21.1%; p<0.001) and a higher rate of heart failure upon presentation (Killip class>2, 11.0% vs 5.9%; p<0.001) compared to patients with IVC. Door to balloon time in patients undergoing acute PCI is markedly delayed in contrast to patients with IVC (280min vs 85min; p<0.001). Consequently, crude mortality in patients with pacemakers was high (11.3% vs 4.6%; p<0.001). However, when analyzed with propensity matching for gender, age, CCI>1 and Killip>2, mortality was similar (11.2% vs 10.5%; p=0.70). CONCLUSION:Pacemaker patients with acute MI represent a high-risk group with doubled crude mortality compared to patients without pacemakers, due to higher age and higher Killip class. Diagnosis is difficult and results in delayed treatment. Treatment algorithms for MI with paced rhythm should possibly be adapted to those used for STEMI or new left bundle branch block. CLINICAL TRIALS REGISTRATION:NCT01305785.

journal_name

Int J Cardiol

journal_title

International journal of cardiology

authors

Bertel N,Witassek F,Puhan M,Erne P,Rickli H,Naegeli B,Pedrazzini G,Stauffer JC,Radovanovic D

doi

10.1016/j.ijcard.2016.12.047

subject

Has Abstract

pub_date

2017-03-01 00:00:00

pages

604-609

eissn

0167-5273

issn

1874-1754

pii

S0167-5273(16)34533-8

journal_volume

230

pub_type

临床试验,杂志文章,多中心研究

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