High-grade atrioventricular block in acute coronary syndromes: insights from the Global Registry of Acute Coronary Events
Authors
Singh, Sheldon M.FitzGerald, Gordon
Yan, Andrew T.
Brieger, David
Fox, Keith A. A.
Lopez-Sendon, Jose
Yan, Raymond T.
Eagle, Kim A.
Steg, Phillippe Gabriel
Budaj, Andrzej
Goodman, Shaun G.
UMass Chan Affiliations
Center for Outcomes ResearchDocument Type
Journal ArticlePublication Date
2014-09-08Keywords
Acute coronary syndromesArtificial pacemaker
Atrioventricular block
Percutaneous coronary intervention
Cardiology
Cardiovascular Diseases
Clinical Epidemiology
Health Services Research
Metadata
Show full item recordAbstract
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 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.Source
Singh SM, FitzGerald G, Yan AT, Brieger D, Fox KA, López-Sendón J, Yan RT, Eagle KA, Steg PG, Budaj A, Goodman SG. High-grade atrioventricular block in acute coronary syndromes: insights from the Global Registry of Acute Coronary Events. Eur Heart J. 2014 Sep 8. doi: 10.1093/eurheartj/ehu357 [Epub ahead of print]DOI
10.1093/eurheartj/ehu357Permanent Link to this Item
http://hdl.handle.net/20.500.14038/27190PubMed ID
25205530Related Resources
Link to article in PubMedae974a485f413a2113503eed53cd6c53
10.1093/eurheartj/ehu357