High-degree atrioventricular block, asystole, and electro-mechanical dissociation complicating non–ST-segment elevation myocardial infarction

Abstract

Background Non–ST-segment myocardial infarction (NSTEMI) can be complicated by high-degree atrioventricular (AV) block, asystole, or electromechanical dissociation (EMD), but these events are not well characterized in the contemporary era. This analysis assesses the incidence of and factors associated with these dysrhythmias in acute NSTEMIs. Methods Patients with NSTEMI in the EARLY ACS, PLATO, and TRACER trials were included in the pooled cohort (N = 29,677). Logistic regression was used to identify factors associated with in-hospital high-degree AV block and asystole or EMD, and Kaplan-Meier methods were used to assess mortality. Results High-degree AV block occurred in 112 (0.4%) patients, asystole in 157 (0.5%), and EMD in 38 (0.1%). Pacemakers were inserted in 241 patients (0.8%) during the index hospitalization: 30 (12%) for AV block. Among patients with high-degree AV block, we observed more frequent right coronary artery lesions (47% vs 29%). Age, diabetes, lower heart rate, and lower blood pressure were associated with high-degree AV block. Higher Killip class, ST-segment depression, prior myocardial infarction, and peripheral vascular disease were most strongly associated with asystole or EMD. Ten-day unadjusted survival was 90% for patients with high-degree AV block and 43% for those with asystole or EMD. Conclusions Although high-degree AV block, asystole, and EMD were infrequent complications of NSTEMI, they were associated with substantial short-term mortality. Only 1 in 8 pacemakers placed in NSTEMI patients during the acute hospitalization was for high-degree AV block.

Nonalcoholic fatty liver disease is associated with an increased risk of heart block in hospitalized patients with type 2 diabetes mellitus

“…We believe that this topic merits further in-depth investigation as it might contribute to explain the increased risk of cardiac morbidity and mortality observed in patients with NAFLD. Indeed, while it is well known that high-degree atrio-ventricular (AV) blocks are powerful predictors of CVD mortality in affected patients [ 15 , 16 ], there is now emerging evidence suggesting that prolonged PR interval, first-degree AV block and RBBB are also associated with poor cardiac prognosis [ 17 – 19 ]. For example, in a meta-analysis of 14 large observational studies (involving a total of nearly 400,000 individuals), Kwok et al .…”

A user-friendly risk-score for predicting in-hospital cardiac arrest among patients admitted with suspected non ST-elevation acute coronary syndrome – The SAFER-score

“…The cause of in-hospital CA is usually ventricular tachycardia (VT) or ventricular fibrillation (VF), reported to occur in 1.5-2.1% of patients 1,2 . Although less common, patients are also at risk of non-VT/VF CA 3 . There are no contemporary clinical risk scores available to estimate the risk of hospital CA using data obtained at the time of admission among patients with suspected NSTE-ACS.…”

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

“…The impact on long-term prognosis remains uncertain but it seems to be more relevant in anterior myocardial infarction. [1][2][3][4][5][6][7][8][9] However, the majority of previous studies dedicated to this complication were performed before the introduction of primary percutaneous coronary intervention (PCI). The aim of the present study was to assess the incidence of complete AV block in patients admitted with ACS, predominantly treated with primary PCI, to characterisze this population and evaluate the prognosis including short and long-term survival.…”