title: Clinical implications of acute myocardial infarction complicated by high grade atrioventricular block.
abstract: BACKGROUND
  The purpose of this study was to assess the incidence, clinical course, prognosis and mean length of stay in acute myocardial infarction (AMI) complicated by high-grade atrioventricular block (HAVB).
  
  
  METHODS
  A retrospective cohort study including all AMI patients listed from January 1995 to September 2000 in the ARIAM multi-center register. Univariate analysis was carried out to study the factors associated with the development of HAVB, the mortality rate, and the mean length of stay, and multivariate logistic regression analysis to study whether HAVB is an independent predictive variable for mortality or prolongation of stay.
  
  
  RESULTS
  Of the 14,181 AMI patients included in the register, 837 (5.9%) presented with HAVB, which was associated with age, female sex, increased severity, diabetes, inferior and Q-wave AMIs, and a higher peak creatine phosphokinase (CPK) level. The HAVB patients developed more complications, required more diagnostic-therapeutic resources, and showed significantly higher mortality (p<0.0001) and increased mean length of stay (p<0.0001). The independent risk factors for HAVB were age, maximum peak CPK, inferior or combined localization of the AMI, Q-wave AMI, diabetes, a Killip and Kimball score > 1, and thrombolysis. HAVB was found to be an independent predictive variable for mortality and increased mean length of stay.
  
  
  CONCLUSIONS
  AMI patients with HAVB, despite thrombolytic treatment, are at risk for complications, mortality and longer mean admissions. Further study is needed on the outcome of a more active reperfusion policy, such as direct, rescue angioplasty etc.
authors.affiliation: Intensive Care Unit, Critical Care and Emergency Department, Hospital de Poniente, El Ejido, Almería, Spain. MRB1604@teleline.es
authors.forename: Manuel
authors.initials: M
authors.lastname: Ruiz-Bailén
authors.forename: Eduardo Aguayo
authors.initials: EA
authors.lastname: de Hoyos
authors.forename: Ziad
authors.initials: Z
authors.lastname: Issa-Khozouz
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Díaz-Castellanos
authors.forename: Asuncion
authors.initials: A
authors.lastname: López-Martinez
authors.forename: Jesus
authors.initials: J
authors.lastname: Calatrava-López
authors.forename: Mercedes
authors.initials: M
authors.lastname: Barranco-Ruiz
authors.forename: Francisco
authors.initials: F
authors.lastname: Ruiz-Ferrón
authors.forename: Humberto José
authors.initials: HJ
authors.lastname: Muńoz-Beltrán
mesh_terms: D000367:Age Factors; D000368:Aged; D005260:Female; D006327:Heart Block / Q000150:complications* / Q000453:epidemiology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications / Q000453:epidemiology* / Q000473:pathology*; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors