Differential clinical implications of high-degree atrioventricular block complicating ST-segment elevation myocardial infarction according to the location of infarction in the era of primary percutaneous coronary intervention

Korea Acute Myocardial Infarction Registry Investigators

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3 Citations (Scopus)

Abstract

Background and Objectives: The clinical implication of high-degree (second- and third-degree) atrioventricular block (HAVB) complicating ST-segment elevation myocardial infarction (STEMI) is ripe for investigation in this era of primary percutaneous coronary intervention (PCI). We sought to address the incidence, predictors and prognosis of HAVB according to the location of infarct in STEMI patients treated with primary PCI. Subjects and Methods: A total of 16536 STEMI patients (anterior infarction: n=9354, inferior infarction: n=7692) treated with primary PCI were enrolled from a multicenter registry. We compared in-hospital mortality between patients with HAVB and those without HAVB with anterior or inferior infarction, separately. Multivariate analyses were performed to unearth predictors of HAVB and to identify whether HAVB is independently associated with in-hospital mortality. Results: STEMI patients with HAVB showed higher in-hospital mortality than those without HAVB in both anterior (hazard ratio [HR]=9.821, 95% confidence interval [CI]: 4.946-19.503, p<0.001) and inferior infarction (HR=2.819, 95% CI: 2.076-3.827, p<0.001). In multivariate analyses, HAVB was associated with increased in-hospital mortality in anterior myocardial infarction (HR=19.264, 95% CI: 5.804-63.936, p<0.001). However, HAVB in inferior infarction was not an independent predictor of increased in-hospital mortality (HR=1.014, 95% CI: 0.547-1.985, p=0.901). Conclusion: In this era of primary PCI, the prognostic impact of HAVB is different according to the location of infarction. Because of recent improvements in reperfusion strategy, the negative prognostic impact of HAVB in inferior STEMI is no longer prominent.

Original languageEnglish
Pages (from-to)315-323
Number of pages9
JournalKorean Circulation Journal
Volume46
Issue number3
DOIs
Publication statusPublished - 2016 May 1

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Atrioventricular Block
Percutaneous Coronary Intervention
Infarction
Hospital Mortality
Confidence Intervals
ST Elevation Myocardial Infarction
Multivariate Analysis
Inferior Wall Myocardial Infarction
Reperfusion
Registries
Myocardial Infarction

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

@article{627d7cc967da4442849826da35a1b755,
title = "Differential clinical implications of high-degree atrioventricular block complicating ST-segment elevation myocardial infarction according to the location of infarction in the era of primary percutaneous coronary intervention",
abstract = "Background and Objectives: The clinical implication of high-degree (second- and third-degree) atrioventricular block (HAVB) complicating ST-segment elevation myocardial infarction (STEMI) is ripe for investigation in this era of primary percutaneous coronary intervention (PCI). We sought to address the incidence, predictors and prognosis of HAVB according to the location of infarct in STEMI patients treated with primary PCI. Subjects and Methods: A total of 16536 STEMI patients (anterior infarction: n=9354, inferior infarction: n=7692) treated with primary PCI were enrolled from a multicenter registry. We compared in-hospital mortality between patients with HAVB and those without HAVB with anterior or inferior infarction, separately. Multivariate analyses were performed to unearth predictors of HAVB and to identify whether HAVB is independently associated with in-hospital mortality. Results: STEMI patients with HAVB showed higher in-hospital mortality than those without HAVB in both anterior (hazard ratio [HR]=9.821, 95{\%} confidence interval [CI]: 4.946-19.503, p<0.001) and inferior infarction (HR=2.819, 95{\%} CI: 2.076-3.827, p<0.001). In multivariate analyses, HAVB was associated with increased in-hospital mortality in anterior myocardial infarction (HR=19.264, 95{\%} CI: 5.804-63.936, p<0.001). However, HAVB in inferior infarction was not an independent predictor of increased in-hospital mortality (HR=1.014, 95{\%} CI: 0.547-1.985, p=0.901). Conclusion: In this era of primary PCI, the prognostic impact of HAVB is different according to the location of infarction. Because of recent improvements in reperfusion strategy, the negative prognostic impact of HAVB in inferior STEMI is no longer prominent.",
author = "{Korea Acute Myocardial Infarction Registry Investigators} and Kim, {Kyung Hwan} and Jeong, {Myung Ho} and Youngkeun Ahn and Kim, {Young Jo} and Cho, {Myeong Chan} and Wan Kim and Chae, {Shung Chull} and Kim, {Jong Hyun} and Hur, {Seung Ho} and Seong, {In Whan} and Donghoon Choi and Chae, {Jei Keon} and Hong, {Taek Jong} and Rhew, {Jae Young} and Kim, {Doo Il} and Chae, {In Ho} and Junghan Yoon and Koo, {Bon Kwon} and Kim, {Byung Ok} and Lee, {Myoung Yong} and Kim, {Kee Sik} and Hwang, {Jin Yong} and Oh, {Seok Kyu} and Lee, {Nae Hee} and Jeong, {Kyoung Tae} and Tahk, {Seung Jea} and Bae, {Jang Ho} and Rha, {Seung Woon} and Park, {Keum Soo} and Kim, {Chong Jin} and Han, {Kyoo Rok} and Ahn, {Tae Hoon} and Kim, {Moo Hyun} and Seung, {Ki Bae} and Chung, {Wook Sung} and Yang, {Ju Young} and Rhim, {Chong Yun} and Gwon, {Hyeon Cheol} and Park, {Seong Wook} and Koh, {Young Youp} and Joo, {Seung Jae} and Kim, {Soo Joong} and Jin, {Dong Kyu} and Cho, {Jin Man} and Yangsoo Jang and Cho, {Jeong Gwan} and Park, {Seung Jung}",
year = "2016",
month = "5",
day = "1",
doi = "10.4070/kcj.2016.46.3.315",
language = "English",
volume = "46",
pages = "315--323",
journal = "Korean Circulation Journal",
issn = "1738-5520",
publisher = "Korean Society of Circulation",
number = "3",

}

TY - JOUR

T1 - Differential clinical implications of high-degree atrioventricular block complicating ST-segment elevation myocardial infarction according to the location of infarction in the era of primary percutaneous coronary intervention

AU - Korea Acute Myocardial Infarction Registry Investigators

AU - Kim, Kyung Hwan

AU - Jeong, Myung Ho

AU - Ahn, Youngkeun

AU - Kim, Young Jo

AU - Cho, Myeong Chan

AU - Kim, Wan

AU - Chae, Shung Chull

AU - Kim, Jong Hyun

AU - Hur, Seung Ho

AU - Seong, In Whan

AU - Choi, Donghoon

AU - Chae, Jei Keon

AU - Hong, Taek Jong

AU - Rhew, Jae Young

AU - Kim, Doo Il

AU - Chae, In Ho

AU - Yoon, Junghan

AU - Koo, Bon Kwon

AU - Kim, Byung Ok

AU - Lee, Myoung Yong

AU - Kim, Kee Sik

AU - Hwang, Jin Yong

AU - Oh, Seok Kyu

AU - Lee, Nae Hee

AU - Jeong, Kyoung Tae

AU - Tahk, Seung Jea

AU - Bae, Jang Ho

AU - Rha, Seung Woon

AU - Park, Keum Soo

AU - Kim, Chong Jin

AU - Han, Kyoo Rok

AU - Ahn, Tae Hoon

AU - Kim, Moo Hyun

AU - Seung, Ki Bae

AU - Chung, Wook Sung

AU - Yang, Ju Young

AU - Rhim, Chong Yun

AU - Gwon, Hyeon Cheol

AU - Park, Seong Wook

AU - Koh, Young Youp

AU - Joo, Seung Jae

AU - Kim, Soo Joong

AU - Jin, Dong Kyu

AU - Cho, Jin Man

AU - Jang, Yangsoo

AU - Cho, Jeong Gwan

AU - Park, Seung Jung

PY - 2016/5/1

Y1 - 2016/5/1

N2 - Background and Objectives: The clinical implication of high-degree (second- and third-degree) atrioventricular block (HAVB) complicating ST-segment elevation myocardial infarction (STEMI) is ripe for investigation in this era of primary percutaneous coronary intervention (PCI). We sought to address the incidence, predictors and prognosis of HAVB according to the location of infarct in STEMI patients treated with primary PCI. Subjects and Methods: A total of 16536 STEMI patients (anterior infarction: n=9354, inferior infarction: n=7692) treated with primary PCI were enrolled from a multicenter registry. We compared in-hospital mortality between patients with HAVB and those without HAVB with anterior or inferior infarction, separately. Multivariate analyses were performed to unearth predictors of HAVB and to identify whether HAVB is independently associated with in-hospital mortality. Results: STEMI patients with HAVB showed higher in-hospital mortality than those without HAVB in both anterior (hazard ratio [HR]=9.821, 95% confidence interval [CI]: 4.946-19.503, p<0.001) and inferior infarction (HR=2.819, 95% CI: 2.076-3.827, p<0.001). In multivariate analyses, HAVB was associated with increased in-hospital mortality in anterior myocardial infarction (HR=19.264, 95% CI: 5.804-63.936, p<0.001). However, HAVB in inferior infarction was not an independent predictor of increased in-hospital mortality (HR=1.014, 95% CI: 0.547-1.985, p=0.901). Conclusion: In this era of primary PCI, the prognostic impact of HAVB is different according to the location of infarction. Because of recent improvements in reperfusion strategy, the negative prognostic impact of HAVB in inferior STEMI is no longer prominent.

AB - Background and Objectives: The clinical implication of high-degree (second- and third-degree) atrioventricular block (HAVB) complicating ST-segment elevation myocardial infarction (STEMI) is ripe for investigation in this era of primary percutaneous coronary intervention (PCI). We sought to address the incidence, predictors and prognosis of HAVB according to the location of infarct in STEMI patients treated with primary PCI. Subjects and Methods: A total of 16536 STEMI patients (anterior infarction: n=9354, inferior infarction: n=7692) treated with primary PCI were enrolled from a multicenter registry. We compared in-hospital mortality between patients with HAVB and those without HAVB with anterior or inferior infarction, separately. Multivariate analyses were performed to unearth predictors of HAVB and to identify whether HAVB is independently associated with in-hospital mortality. Results: STEMI patients with HAVB showed higher in-hospital mortality than those without HAVB in both anterior (hazard ratio [HR]=9.821, 95% confidence interval [CI]: 4.946-19.503, p<0.001) and inferior infarction (HR=2.819, 95% CI: 2.076-3.827, p<0.001). In multivariate analyses, HAVB was associated with increased in-hospital mortality in anterior myocardial infarction (HR=19.264, 95% CI: 5.804-63.936, p<0.001). However, HAVB in inferior infarction was not an independent predictor of increased in-hospital mortality (HR=1.014, 95% CI: 0.547-1.985, p=0.901). Conclusion: In this era of primary PCI, the prognostic impact of HAVB is different according to the location of infarction. Because of recent improvements in reperfusion strategy, the negative prognostic impact of HAVB in inferior STEMI is no longer prominent.

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U2 - 10.4070/kcj.2016.46.3.315

DO - 10.4070/kcj.2016.46.3.315

M3 - Article

AN - SCOPUS:84979656058

VL - 46

SP - 315

EP - 323

JO - Korean Circulation Journal

JF - Korean Circulation Journal

SN - 1738-5520

IS - 3

ER -