56-75: High-grade atrioventricular block in acute coronary syndromes: predictors and in-hospital prognosis

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 in ACS patients receiving contemporary management. Aim: To determine the incidence of HAVB in ACS patients, identify the predictors of this complication and its prognostic impact during hospitalization. Methods: We analyzed data from 11781 patients admitted for ACS and included in a multicentric national registry. All clinical, electrocardiographic and angiographic variables were collected. Multivariate analysis was performed to establish the independent predictors of HAVB. The incidence of cardiac death an MACCE defined as a composite of cardiac death, re-infarction, stroke and non-fatal cardiac arrest were also assessed. Results: HAVB occurred in 396 patients (3.4%). It was more frequent in women and elderly (≥75 years), patients with previous history of cerebrovascular disease, renal failure or cancer, patients with ST-elevation myocardial infarction (STEMI) and those with cardiogenic shock at admission or syncope or cardiac arrest as presentation symptoms (p , 0.05). Coronary angiography revealed a higher incidence of multivessel disease in HAVB patients and the culprit lesion was more frequently in right coronary artery. In multivariate analysis inferior STEMI, smoking and cardiogenic shock at admission were independent predictors of HAVB and percutaneous coronary intervention (PCI) was associated with lower risk of its occurrence (Table 1), area under the curve ROC: 0.926. During hospitalization, HAVB was associated with higher cardiac mortality (22.2% vs 2.8%, p , 0.001) and MACCE (29.2% vs 6.4%, p , 0.001). In the multivariate analysis HAVB proved to be an independent predictor of cardiac death (Odds Ratio (OR): 9.57, 95% Confidence Interval (95% CI): 4.81-19.02, p , 0.001) and MACCE (OR: 2.52, 95% CI: 1.67-3.77, p , 0.001). Conclusion: Although the incidence of HAVB in ACS patients is low, it carries a poor in-hospital prognosis. Patients presenting with inferior STEMI, cardiogenic shock and those who are smokers are at increased risk. Early PCI can avoid some of these complications (Table Presented).