Implant of permanent pacemaker during acute coronary syndrome: Mortality and associated factors in the ARIAM registry

Abstract

Background: Patients with acute coronary syndrome complicated with high degree atrioventricular block still have a high mortality. A low percentage of these patients need a permanent pacemaker (PPM) but mortality and associated factors with the PPM implant in acute coronary syndrome patients are not known. We assess whether PPM implant is an independent variable in the mortality of acute coronary syndrome patients. Also, we explored the variables that remain independently associated with PPM implantation. Methods: This was an observational study on the Spanish ARIAM register. The inclusion period was from January 2001 to December 2011. This registry included all Andalusian acute coronary syndrome patients. Follow-up for global mortality was until November 2013. Results: We selected 27,608 cases. In 62 patients a PPM was implanted (0.024%). The mean age in PPM patients was 70.71±11.214 years versus 64.46±12.985 years in patients with no PPM. PPM implant was associated independently with age (odds ratio (OR) 1.031, 95% confidence interval (CI) 1.007–1.055), with left ventricular branch block (OR 6.622, 95% CI 2.439–18.181), with any arrhythmia at intensive care unit admission (OR 2.754, 95% CI 1.506–5.025) and with heart failure (OR 3.344, 95% CI 1.78–8.333). PPM implant was independently associated with mortality (OR 11.436, 95% CI 1.576–83.009). In propensity score analysis PPM implant was still associated with mortality (OR 5.79, 95% CI 3.27–25.63). Conclusion: PPM implant is associated with mortality in the acute coronary syndrome population in the ARIAM registry. Advanced age, heart failure, arrhythmias and left ventricular branch block at intensive care unit admission were found associated factors with PPM implant in acute coronary syndrome patient.