title: High-degree atrioventricular block complicating ST segment elevation myocardial infarction in the contemporary era.
abstract: BACKGROUND
  High-degree atrioventricular block (HAVB) is a common complication of ST segment elevation myocardial infarction (STEMI). HAVB in STEMI is historically considered as a marker of worse outcome but overall data about HAVB in the contemporary era of mechanical reperfusion and potent antiplatelet therapies are scarce.
  
  
  OBJECTIVE
  Analysing incidence, clinical correlates and impact on inhospital outcomes of HAVB in a large prospective registry (Observatoire Régional Breton sur l'Infarctus, ORBI) of modern management of STEMI with a special focus on potential differences between patients with HAVB on admission and those who developed HAVB during hospitalisation.
  
  
  METHODS
  All patients enrolled in ORBI between June 2006 and December 2013 were included in the present analysis and were divided into 3 groups: patients without HAVB at any time, patients with HAVB on admission and those who developed HAVB during hospitalisation.
  
  
  RESULTS
  A total of 6662 patients (age: 62.0 (52.0-74.0) years; male: 76.3%) were included in the present analysis. HAVB was documented in 3.5% of patients, present on admission in 63.7% of patients and occurring during hospitalisation in 36.3%. Patients with HAVB on admission or occurring during the first 24 h of hospitalisation had higher inhospital mortality rates (18.1% and 28.6%, respectively) than patients without (4.5%) or with HAVB occurring beyond the first 24 h of hospitalisation (8.0%). However by multivariable analysis, HAVB was not independently associated with inhospital mortality contrarily to age, presentation as cardiac arrest, anterior STEMI location, reperfusion therapy, cardiogenic shock, mechanical ventilation and occurrence of sustained ventricular tachyarrhythmias or mechanical complication.
  
  
  CONCLUSIONS
  Patients with HAVB had a higher mortality rate than patients without. However HAVB is not an independent predictor of inhospital mortality.
authors.affiliation: CHU Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, France Université de Rennes 1, LTSI, Rennes, France INSERM, U1099, Rennes, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Auffret
authors.affiliation: CHU Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, France Université de Rennes 1, LTSI, Rennes, France INSERM, U1099, Rennes, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Loirat
authors.affiliation: CHU Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, France Université de Rennes 1, LTSI, Rennes, France INSERM, U1099, Rennes, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Leurent
authors.affiliation: CHU Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, France Université de Rennes 1, LTSI, Rennes, France INSERM, U1099, Rennes, France.
authors.forename: Raphael P
authors.initials: RP
authors.lastname: Martins
authors.affiliation: CH de Vannes, Service de Cardiologie, Vannes, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Filippi
authors.affiliation: CH de Saint-Brieuc, SAMU, Saint Brieuc, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Coudert
authors.affiliation: CH de Lorient, Service de Cardiologie, Lorient, France.
authors.forename: Jean Philippe
authors.initials: JP
authors.lastname: Hacot
authors.affiliation: Département de Cardiologie, CHU de Brest, Brest, France EA4324, Optimisation des Régulations Physiologiques (ORPhy), UFR Sciences et Techniques, Brest, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Gilard
authors.affiliation: Département de Cardiologie, CHU de Brest, Brest, France EA4324, Optimisation des Régulations Physiologiques (ORPhy), UFR Sciences et Techniques, Brest, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Castellant
authors.affiliation: CH de Saint Malo, Service de Cardiologie, Saint Malo, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Rialan
authors.affiliation: CH de Saint Brieuc, Service de Cardiologie, Saint Brieuc, France.
authors.forename: Régis
authors.initials: R
authors.lastname: Delaunay
authors.affiliation: CH de Quimper, Service de Cardiologie, Quimper, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Rouault
authors.affiliation: Clinique Saint Laurent, Service de Cardiologie, Rennes, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Druelles
authors.affiliation: CH de Vannes, SAMU, Vannes, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Boulanger
authors.affiliation: CHU de Brest, SAMU, Brest, France.
authors.forename: Josiane
authors.initials: J
authors.lastname: Treuil
authors.affiliation: CHU de Rennes, Service des Urgences médicales, Rennes, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Avez
authors.affiliation: CHU Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, France Université de Rennes 1, LTSI, Rennes, France INSERM, U1099, Rennes, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Bedossa
authors.affiliation: CHU Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, France Université de Rennes 1, LTSI, Rennes, France INSERM, U1099, Rennes, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Boulmier
authors.affiliation: CHU Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, France Université de Rennes 1, LTSI, Rennes, France INSERM, U1099, Rennes, France.
authors.forename: Marielle
authors.initials: M
authors.lastname: Le Guellec
authors.affiliation: CHU Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, France Université de Rennes 1, LTSI, Rennes, France INSERM, U1099, Rennes, France.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Daubert
authors.affiliation: CHU Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, France Université de Rennes 1, LTSI, Rennes, France INSERM, U1099, Rennes, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Le Breton
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D054537:Atrioventricular Block / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D005602:France; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D015425:Myocardial Reperfusion; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors