Trends in Complete Heart Block in STEMI
What are the data on contemporary prevalence and outcomes associated with complete heart block (CHB) in patients with ST-segment elevation myocardial infarction (STEMI)?
The authors used the 2003-2012 National Inpatient Sample databases to identify patients with CHB among all patients ages ≥18 years hospitalized with STEMI. Logistic regression was used to analyze the association of CHB with outcomes.
CHB was noted in 49,882 (2.2%) of the 2,273,853 patients with STEMI. The incidence of CHB increased from 2.1% in 2003 to 2.3% in 2012 (adjusted odds ratio per year, 1.02; 95% confidence interval [CI], 1.02-1.03). STEMI patients with CHB had higher in-hospital mortality (20.4% vs. 8.7%; adjusted OR, 2.47; 95% CI, 2.41-2.53). CHB was more common in association with inferior MI (3.8% vs. 0.9%) compared with anterior MI. The higher mortality associated with CHB was independent of the location of STEMI, but the magnitude of this association was greatest in patients with anterior STEMI. The mortality associated with CHB in STEMI remained unchanged during the study period (adjusted OR per year, 1.00; 95% CI, 0.99-1.01).
CHB is uncommon in patients with STEMI and is associated with a high mortality.
CHB was more frequently observed in the pre-thrombolytic era and even in the early days of thrombolysis, but has become infrequent in contemporary practice. The prognostic implications of CHB in this population are well recognized. This study confirms that the incidence of CHB is low, but the mortality in association with it remains high.
Keywords: Acute Coronary Syndrome, Fibrinolytic Agents, Heart Block, Hospital Mortality, Inferior Wall Myocardial Infarction, Myocardial Infarction, Outcome Assessment (Health Care), Prevalence
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