title: Admission clinical and electrocardiographic characteristics predicting in-hospital development of high-degree atrioventricular block in inferior wall acute myocardial infarction.
abstract: This study assessed the ability of simple clinical and electrocardiographic variables routinely obtained on admission to identify patients who are at high risk of developing high-degree atrioventricular (AV) block during hospitalization in 1,336 patients with inferior wall acute myocardial infarction (AMI). Patients were classified into 2 initial electrocardiographic patterns based on the J-point to R-wave amplitude ratio: pattern 1: those with J point/R wave <0.5 and pattern 2: patients with J point/R wave > or =0.5 in > or =2 leads of the inferior leads II, III, and aVF. High-degree AV block was found in 6.7% of patients (41 of 615) with pattern 1 versus 11.8% of the patients (85 of 721) with pattern 2 on admission electrocardiogram (p = 0.0008). Multivariate logistic regression analysis revealed that the only variables found to be independently associated with high-degree AV block were female gender (odds ratio [OR] 1.48; 95% confidence interval [CI] 0.98 to 2.23; p = 0.06); Killip class on admission > or =2 (OR 2.24; CI 1.43 to 3.51; p = 0.0004); initial electrocardiographic pattern 2 versus pattern 1 (OR 1.82; CI 1.22 to 2.21; p = 0.003); and absence of abnormal Q waves on admission (OR yes vs no 0.68; CI 0.44 to 1.05; p = 0.08). A simple electrocardiographic sign (J point/R wave > or =0.5 in > or =2 leads) is a reliable predictor of the development of advanced AV block among patients receiving thrombolytic therapy for inferior wall AMI.
authors.affiliation: Beilinson Medical Center, Petah-Tiqva, Israel.
authors.forename: Y
authors.initials: Y
authors.lastname: Birnbaum
authors.forename: S
authors.initials: S
authors.lastname: Sclarovsky
authors.forename: I
authors.initials: I
authors.lastname: Herz
authors.forename: B
authors.initials: B
authors.lastname: Zlotikamien
authors.forename: A
authors.initials: A
authors.lastname: Chetrit
authors.forename: L
authors.initials: L
authors.lastname: Olmer
authors.forename: G I
authors.initials: GI
authors.lastname: Barbash
mesh_terms: D016022:Case-Control Studies; D004562:Electrocardiography; D005260:Female; D006327:Heart Block / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012307:Risk Factors; D015912:Thrombolytic Therapy