Sheldon M Singh1, Gordon FitzGerald2, Andrew T Yan3, David Brieger4, Keith A A Fox5, Jose López-Sendón6, Raymond T Yan7, Kim A Eagle8, Ph Gabriel Steg9, Andrzej Budaj10, Shaun G Goodman11. 1. Division of Cardiology, Department of Medicine, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada. 2. Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA. 3. Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Toronto, Canada. 4. Coronary Care Unit, Concord Hospital, Sydney, Australia. 5. Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK. 6. Hospital Universitario La Paz, Madrid, Spain. 7. University of Toronto, Toronto, Canada. 8. University of Michigan Medical Center, Ann Arbor, MI, USA. 9. Hôpital Bichat, Assistance Publique, Hôpitaux de Paris, Paris, France. 10. Grochowski Hospital, Warsaw, Poland. 11. Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Toronto, Canada Canadian Heart Research Centre, Toronto, Canada Division of Cardiology, St Michael's Hospital, 30 Bond Street, Room 6-034 Queen, Toronto, Ontario, Canada M5B 1W8 goodmans@smh.ca.
Abstract
BACKGROUND: While prior work has suggested that a high-grade atrioventricular block (HAVB) in the setting of an acute coronary syndrome (ACS) is associated with in-hospital death, limited information is available on the incidence of, and death associated with, HAVB in ACS patients receiving contemporary management. METHODS AND RESULTS: The incidence of HAVB was determined within The Global Registry of Acute Coronary Events (GRACE). The clinical characteristics, in-hospital therapies, and outcomes were compared between patients with and without HAVB. Factors associated with death in patients with HAVB were determined. A total of 59 229 patients with ACS between 1999 and 2007 were identified; 2.9% of patients had HAVB at any point during the index hospitalization; 22.7% of whom died in hospital [adjusted odds ratio (OR) = 4.2, 95% confidence interval (CI), 3.6-4.9, P < 0.001]. The association between HAVB and in-hospital death varied with type of ACS [OR: ST-segment elevation myocardial infarction (STEMI) = 3.0; non-STEMI = 6.4; unstable angina = 8.2, P for interaction < 0.001]. High-grade atrioventricular block present at the time of presentation to hospital (vs. occurring in-hospital) and early (<12 h) percutaneous coronary intervention or fibrinolysis (vs.>12 h or no intervention) were associated with improved in-hospital survival, whereas temporary pacemaker insertion was not. Patients with HAVB surviving to discharge had similar adjusted survival at 6 months compared with those without HAVB. A reduction in the rate of, but not in-hospital mortality associated with, HAVB was noted over the study period. CONCLUSION: Although the incidence of HAVB is low and decreasing, this complication continues to have a high risk of in-hospital death. Published on behalf of the European Society of Cardiology. All rights reserved.
BACKGROUND: While prior work has suggested that a high-grade atrioventricular block (HAVB) in the setting of an acute coronary syndrome (ACS) is associated with in-hospital death, limited information is available on the incidence of, and death associated with, HAVB in ACS patients receiving contemporary management. METHODS AND RESULTS: The incidence of HAVB was determined within The Global Registry of Acute Coronary Events (GRACE). The clinical characteristics, in-hospital therapies, and outcomes were compared between patients with and without HAVB. Factors associated with death in patients with HAVB were determined. A total of 59 229 patients with ACS between 1999 and 2007 were identified; 2.9% of patients had HAVB at any point during the index hospitalization; 22.7% of whom died in hospital [adjusted odds ratio (OR) = 4.2, 95% confidence interval (CI), 3.6-4.9, P < 0.001]. The association between HAVB and in-hospital death varied with type of ACS [OR: ST-segment elevation myocardial infarction (STEMI) = 3.0; non-STEMI = 6.4; unstable angina = 8.2, P for interaction < 0.001]. High-grade atrioventricular block present at the time of presentation to hospital (vs. occurring in-hospital) and early (<12 h) percutaneous coronary intervention or fibrinolysis (vs.>12 h or no intervention) were associated with improved in-hospital survival, whereas temporary pacemaker insertion was not. Patients with HAVB surviving to discharge had similar adjusted survival at 6 months compared with those without HAVB. A reduction in the rate of, but not in-hospital mortality associated with, HAVB was noted over the study period. CONCLUSION: Although the incidence of HAVB is low and decreasing, this complication continues to have a high risk of in-hospital death. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Alexander C Fanaroff; Eric D Peterson; Anita Y Chen; Laine Thomas; Jacob A Doll; Christopher B Fordyce; L Kristin Newby; Ezra A Amsterdam; Mikhail N Kosiborod; James A de Lemos; Tracy Y Wang Journal: JAMA Cardiol Date: 2017-01-01 Impact factor: 14.676
Authors: Cosme García-García; Teresa Oliveras; Jordi Serra; Joan Vila; Ferran Rueda; German Cediel; Carlos Labata; Marc Ferrer; Xavier Carrillo; Irene R Dégano; Oriol De Diego; Nabil El Ouaddi; Santiago Montero; Josepa Mauri; Roberto Elosua; Josep Lupón; Antoni Bayes-Genis Journal: J Am Heart Assoc Date: 2020-10-15 Impact factor: 5.501