Complete atrioventricular block in acute coronary syndrome: prevalence, characterisation and implication on outcome

Rosa, Sílvia Aguiar; Timóteo, Ana Teresa; Ferreira, Lurdes; Carvalho, Ramiro; Oliveira, M.; Cunha, Pedro Silva; Monteiro, André; Portugal, Guilherme; Morais, L Almeida; Daniel, Pedro; Ferreira, Rui Cruz

doi:10.1177/2048872617716387

Cited by 26 publications

(21 citation statements)

References 17 publications

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“…The incidence of complete AV block in our study was 2.3% in overall population and 3.6% in STEMI population. This is slightly higher than in Western studies by Aguiar et al 36 (1.9% in ACS population) and Harikrishnan et al 37 (2.1%-2.3% in STEMI).…”

Section: Discussioncontrasting

confidence: 51%

Clinical Characteristics, Management Strategies, and In-Hospital Outcomes of Acute Coronary Syndrome in a Low Socioeconomic Status Cohort: An Observational Study From Urban India

Sidhu

Rangaiah

et al. 2020

Clin Med Insights Cardiol

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Background: Coronary artery disease is the leading cause of mortality in India. There is scarcity of data on demographic profile and outcomes of acute coronary syndrome (ACS) in low socioeconomic status (SES) population of India. Objectives: This study was undertaken to determine the clinical presentation, management strategies, and in-hospital outcomes of ACS in low SES population. Methods: We conducted 1-year prospective observational cohort study of ACS patients admitted at Employees State Insurance Corporation unit of our tertiary care cardiac center. Clinical parameters, management strategies, and in-hospital outcomes of 621 patients enrolled during the study period from February 2015 to January 2016 were studied. Results: Mean age of patients was 56.06 ± 11.29 years. Majority (62%) of the patients had ST elevation myocardial infarction (STEMI), whereas Non-ST elevation acute coronary syndrome (NSTE-ACS) was seen in 38% of the patients. Median time from symptom onset to hospital admission was 285 min with wide range from 105 to 1765 min. Coronary angiography was performed in 81% of patient population. Single-vessel disease (SVD) was the most common pattern (seen in 43.3%) of coronary artery involvement with left anterior descending coronary artery (LAD) being the most frequently involved vessel (62.8%). Pharmaco-invasive approach was the preferred strategy. Overall percutaneous coronary intervention (PCI) rates were 59.1% (62.1% in STEMI and 54.2% in NSTE-ACS). Overall in-hospital mortality was 3.2%, being significantly higher in STEMI (4.2%) as compared with NSTE-ACS (1.7%). Conclusions: With implementation of evidence-based pharmacotherapy and interventions, outcomes comparable with developed countries can be achieved even in low SES populations of developing world.

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Section: Discussioncontrasting

confidence: 51%

Clinical Characteristics, Management Strategies, and In-Hospital Outcomes of Acute Coronary Syndrome in a Low Socioeconomic Status Cohort: An Observational Study From Urban India

Sidhu

Rangaiah

et al. 2020

Clin Med Insights Cardiol

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“…The association between CAVB and worse outcomes has been reported in several studies 1‐4,21,22 . Nguyen et al showed that AMI patients with CAVB had a higher hospital mortality than those without CAVB (43% vs 13%) 1 .…”

Section: Discussionmentioning

confidence: 83%

“…The definition of AVB are different and it is not unified in many articles. For example, AVB was defined as “advanced” or “high‐degree” AVB in some studies, 5,10‐13,16‐20 while only CAVB was reported in others 1‐4,6‐9,21,22 . Moreover, monitoring timing was different whether it was recorded at admission or during hospitalization.…”

Section: Discussionmentioning

confidence: 99%

Clinical impact of complete atrioventricular block in patients with ST‐segment elevation myocardial infarction

Kawamura

Yokoyama

Kitayama

et al. 2020

Clinical Cardiology

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Complete atrioventricular block (CAVB) is a common complication of ST‐segment elevation myocardial infarction (STEMI). Although STEMI patients complicated with CAVB had a higher mortality in the thrombolytic era, little is known about the impact of CAVB on STEMI patients who underwent primary percutaneous coronary intervention (PCI). The study aimed at evaluating the clinical impact of CAVB on STEMI patients in the primary PCI era. We consecutively enrolled 1295 STEMI patients undergoing primary PCI within 24 hours from onset. Patients were divided into two groups according to the infarct location: anterior STEMI (n = 640) and nonanterior STEMI (n = 655). The outcomes were all‐cause death and major adverse cardiocerebrovascular events (MACCE) with a median follow‐up period of 3.8 (1.7–6.6) years. Eighty‐one patients (6.3%) developed CAVB. The incidence of CAVB was lower in anterior STEMI patients than in nonanterior STEMI (1.7% vs 10.7%, p < .05). Anterior STEMI patients with CAVB had a higher incidence of all‐cause deaths (82% vs 20%, p < .05) and MACCE (82% vs 25%, p < .05) than those without CAVB. Although higher incidence of all‐cause deaths was found more in nonanterior STEMI patients with CAVB compared with those without CAVB (30% vs 18%, p < .05), there was no significant difference in the incidence of MACCE (24% vs 19%). Multivariate analysis showed that CAVB was an independent predictor for all‐cause mortality and MACCE in anterior STEMI patients, but not in nonanterior STEMI. CAVB is rare in anterior STEMI patients, but remains a poor prognostic complication even in the primary PCI era.

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“…In particular, patients with inferior MI develop CAVB in increased frequency as compared with other patients. STEMI increases the risk of CAVB compared with patients with non-STEMI [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of Primary Percutaneous Coronary Intervention on Complete Atrioventricular Block With Acute Inferior ST-Elevation Myocardial Infarction

Malik

Laique

Farooq

et al. 2020

Cureus

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Background and aims Complete atrioventricular block (CAVB) is associated with poor clinical outcomes in ST-elevation myocardial infarction (STEMI). This study determined the frequency and outcomes of primary percutaneous coronary intervention (PPCI) in patients with CAVB with acute inferior STEMI. Methods We conducted an observational, prospective study and enrolled 151 patients who were diagnosed with inferior STEMI. All patients received PPCI. The clinical outcomes were compared in patients with and without CAVB. The data was recorded on a collection form and analyzed on Statistical Package for Social Sciences (SPSS) software. Descriptive statistics were applied. For quantitative variables, standard deviation and mean were obtained, and statistical tests were also applied. Results Baseline characteristics were homogeneous in all patients. Half of the study population was either diabetic or hypertensive. Out of 151 participants, 21 (13.9%) developed CAVB. Two-thirds of the patients, who had developed heart block, reverted after PPCI. After a follow-up of two weeks, in-hospital mortality did not differ between the groups. Conclusion We conclude that PPCI can improve outcomes of CAVB-complicated acute inferior STEMI and suggest that primary PCI should be the preferred reperfusion therapy in patients with CAVB with STEMI.

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Complete atrioventricular block in acute coronary syndrome: prevalence, characterisation and implication on outcome

Abstract: Complete atrioventricular block conferred a worse outcome during hospitalisation, including a higher incidence of cardiogenic shock, ventricular arrhythmias and death.

Cited by 26 publications

References 17 publications

Clinical Characteristics, Management Strategies, and In-Hospital Outcomes of Acute Coronary Syndrome in a Low Socioeconomic Status Cohort: An Observational Study From Urban India

Clinical Characteristics, Management Strategies, and In-Hospital Outcomes of Acute Coronary Syndrome in a Low Socioeconomic Status Cohort: An Observational Study From Urban India

Clinical impact of complete atrioventricular block in patients with ST‐segment elevation myocardial infarction

Impact of Primary Percutaneous Coronary Intervention on Complete Atrioventricular Block With Acute Inferior ST-Elevation Myocardial Infarction

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