Complete atrioventricular block complicating inferior acute wall myocardial infarction: short- and long-term prognosis.
The incidence of complete atrioventricular block (AVB) in a large group of patients with Q-wave inferior acute myocardial infarction (AMI) was 251 (11%) of 2273 patients. This incidence was significantly higher in women (14%) and patients > 70 years old (15%) than in men and patients < 70 years old (10% and 9%, respectively). Patients with complete AVB exhibited more serious arrhythmic and mechanical complications during hospitalization and included more patients with very high enzyme levels than their counterparts without AVB. The in-hospital mortality rate was 92 (37%) of 251 patients with complete AVB versus 200 (11%) of 1890 in those without AVB (p < 0.0001). After adjustment for age, gender, and important anamnestic, medical, and enzymatic findings, complete AVB emerged as an independent predictor of in-hospital mortality, yielding an odds ratio of 2.0 (90% confidence interval 1.12 to 3.57). The long-term (5-year) mortality rate in hospital survivors was slightly but not significantly higher in patients with complete AVB (28%) during hospitalization than in their counterparts with no AVB (23%). In view of these data, patients with inferior AMI in whom complete AVB develops are at increased risk and may benefit from urgent revascularization; the postdischarge management of survivors with complete AVB should be no different from that of patients without AVB.
SPRINT Study Group, Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Hashomer, Israel.
S
S
Behar
E
E
Zissman
M
M
Zion
U
U
Goldbourt
H
H
Reicher-Reiss
Y
Y
Shalev
H
H
Hod
E
E
Kaplinsky
A
A
Caspi
D000368:Aged; D001283:Atrioventricular Node; D005260:Female; D006327:Heart Block / Q000453:epidemiology / Q000209:etiology / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality*; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis