High-grade atrioventricular block in acute coronary syndromes: insights from the Global Registry of Acute Coronary Events
Center for Outcomes Research
Cardiology | Cardiovascular Diseases | Clinical Epidemiology | Health Services Research
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.
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Citation: 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]
Acute coronary syndromes, Artificial pacemaker, Atrioventricular block, Percutaneous coronary intervention
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; and Goodman, Shaun G., "High-grade atrioventricular block in acute coronary syndromes: insights from the Global Registry of Acute Coronary Events" (2014). GRACE Publications. 119.