Bundle branch and atrioventricular block as complications of acute myocardial infarction in the thrombolytic era.
OBJECTIVE
To analyze the incidence of intraventricular and atrioventricular conduction defects associated with acute myocardial infarction and the degree of in hospital mortality resulting from this condition during the era of thrombolytic therapy.


METHODS
Observational study of a cohort of 929 consecutive patients with acute myocardial infarction. Multivariate analysis by logistic regression. Was used.


RESULTS
Logistic regression showed a greater incidence of bundle branch block in male sex (odds ratio = 1.87, 95% CI = 1.02-3.42), age over 70 years (odds ratio = 2.31, 95% CI = 1.68-5.00), anterior localization of the infarction (odds ratio = 1.93, 95% CI = 1.03-3.65). There was a greater incidence of complete atrioventricular block in inferior infarcts (odds ratio = 2.59, 95% CI 1.30-5.18) and the presence of cardiogenic shock (odds ratio = 3.90, 95% CI = 1.43-10.65). Use of a thrombolytic agent was associated with a tendency toward a lower occurrence of bundle branch block (odds ratio = 0.68) and a greater occurrence of complete atrioventricular block (odds ratio = 1.44). The presence of bundle branch block (odds ratio = 2.45 95%, CI = 1.14-5.28) and of complete atrioventricular block (odds ratio = 13.59, 95% CI = 5.43-33.98) was associated with a high and independent probability of inhospital death.


CONCLUSIONS
During the current era of thrombolytic therapy and in this population, intraventricular disturbances of electrical conduction and complete atrioventricular block were associated with a high and independent risk of inhospital death during acute myocardial infarction.
Escosteguy
C C
CC
Hospital dos Servidores do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
Carvalho
M de A
Mde A
Medronho
R de A
Rde A
Abreu
L M
LM
Monteiro Filho
M Y
MY
D000368:Aged; D002037:Bundle-Branch Block / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006327:Heart Block / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy; D011379:Prognosis; D013923:Thromboembolism / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D015912:Thrombolytic Therapy
D005343:Fibrinolytic Agents