title: Periprocedural temporary pacing in primary percutaneous coronary intervention for patients with acute inferior myocardial infarction.
abstract: OBJECTIVE
  High-degree atrioventricular block (AVB), including complete AVB in acute inferior ST-elevation myocardial infarction (STEMI), is not uncommon. However, there is no study evaluating the clinical differences between patients who have undergone temporary pacing (TP) and patients who have not. The present study was designed to investigate whether TP has any prognostic significance in inferior STEMI complicated by complete AVB.
  
  
  METHODS
  From January 2009 to December 2014, 295 consecutive patients diagnosed with inferior wall STEMI in a university hospital were reviewed. All of them underwent primary percutaneous coronary intervention (PCI). Among the 295 patients, there were 72 patients with complete AVB. The clinical characteristics, procedural data, and long-term major adverse cardiocerebrovascular events were compared in patients with and without TP.
  
  
  RESULTS
  Baseline clinical and procedural characteristics were similar between patients with and without TP. Patients with TP were more likely to present with cardiogenic shock; thus, additional interventions were attempted via a femoral approach, as patients received further treatment with intra-aortic balloon pumps and were subjected to additional cardiopulmonary resuscitation. Most cases of complete AVB were primarily caused by right coronary artery occlusion. After a median follow-up period of 344 (range, 105.5-641) days, major adverse cardiocerebrovascular events did not differ between the groups (P=0.528).
  
  
  CONCLUSIONS
  We conclude that primary PCI without TP is acceptable in complete AVB-complicated acute inferior STEMI. To avoid delay in reperfusion, we suggest that primary PCI should be the first priority therapy rather than treating patients initially with TP.
authors.affiliation: Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: You Mi
authors.initials: YM
authors.lastname: Hwang
authors.affiliation: Department of Internal Medicine, St Vincent's Hospital, The Catholic University of Korea, Suwon, South Korea.
authors.forename: Chul-Min
authors.initials: CM
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, St Vincent's Hospital, The Catholic University of Korea, Suwon, South Korea.
authors.forename: Keon-Woong
authors.initials: KW
authors.lastname: Moon
mesh_terms: D000368:Aged; D054537:Atrioventricular Block / Q000175:diagnosis / Q000628:therapy*; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D056989:Inferior Wall Myocardial Infarction / Q000150:complications* / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D059035:Perioperative Period / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
keywords: complete atrioventricular block; myocardial infarction; primary percutaneous coronary intervention; temporary pacemaker