title: Influence of second- and third-degree heart block on 30-day outcome following acute myocardial infarction in the drug-eluting stent era.
abstract: This study was conducted to investigate the prognostic value of heart block among patients with acute myocardial infarction (AMI) treated with drug-eluting stents. A total of 13,862 patients with AMI, registered in the nation-wide AMI database from January 2005 to June 2013, were analyzed. Second- (Mobitz type I or II) and third-degree atrioventricular block were considered as heart block in this study. Thirty-day major adverse cardiac events (MACE) including all causes of death, recurrent myocardial infarction, and revascularization were evaluated. Percutaneous coronary intervention with implantation of drug-eluting stent was performed in 89.8% of the patients. Heart block occurred in 378 patients (2.7%). Thirty-day MACE occurred in 1,144 patients (8.2%). Patients with heart block showed worse clinical parameters at initial admission, and the presence of heart block was associated with 30-day MACE in univariate analyses. However, the prognostic impact of heart block was not significant after adjustment of potential confounders (p = 0.489). Among patients with heart block, patients with a culprit in the left anterior descending (LAD) coronary artery had worse clinical outcomes than those of patients with a culprit in the left circumflex or right coronary artery. LAD culprit was a significant risk factor for 30-day MACE even after controlling for confounders (odds ratio 5.28, 95% confidence interval 1.22 to 22.81, p = 0.026). In conclusion, despite differences in clinical parameters at the initial admission, heart block was not an independent risk factor for 30-day MACE in adjusted analyses. However, a LAD culprit was an independent risk factor for 30-day MACE among patients with heart block.
authors.affiliation: Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Hack-Lyoung
authors.initials: HL
authors.lastname: Kim
authors.affiliation: Seoul National University Boramae Medical Center, Seoul, Korea. Electronic address: shkimmd@snu.ac.kr.
authors.forename: Sang-Hyun
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Jae-Bin
authors.initials: JB
authors.lastname: Seo
authors.affiliation: Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Woo-Young
authors.initials: WY
authors.lastname: Chung
authors.affiliation: Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Joo-Hee
authors.initials: JH
authors.lastname: Zo
authors.affiliation: Seoul National University Boramae Medical Center, Seoul, Korea.
authors.forename: Myung-A
authors.initials: MA
authors.lastname: Kim
authors.affiliation: Seoul National University Hospital, Seoul, Korea.
authors.forename: Kyung-Woo
authors.initials: KW
authors.lastname: Park
authors.affiliation: Seoul National University Hospital, Seoul, Korea.
authors.forename: Bon-Kwon
authors.initials: BK
authors.lastname: Koo
authors.affiliation: Seoul National University Hospital, Seoul, Korea.
authors.forename: Hyo-Soo
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: In-Ho
authors.initials: IH
authors.lastname: Chae
authors.affiliation: Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Dong-Ju
authors.initials: DJ
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, Chungbuk National University, Cheongju, Korea.
authors.forename: Myeong-Chan
authors.initials: MC
authors.lastname: Cho
authors.affiliation: Yeungnam University Hospital, Daegu, Korea.
authors.forename: Young-Jo
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Chonnam National University Hospital, Gwangju, Korea.
authors.forename: Ju Han
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Chonnam National University Hospital, Gwangju, Korea.
authors.forename: Youngkeun
authors.initials: Y
authors.lastname: Ahn
authors.affiliation: Chonnam National University Hospital, Gwangju, Korea.
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy*; D054855:Drug-Eluting Stents; D005260:Female; D006327:Heart Block / Q000209:etiology* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D012042:Registries; D056910:Republic of Korea; D016896:Treatment Outcome