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Original article
High-degree atrioventricular block complicating ST segment elevation myocardial infarction in the contemporary era
  1. Vincent Auffret1,2,3,
  2. Aurélie Loirat1,2,3,
  3. Guillaume Leurent1,2,3,
  4. Raphael P Martins1,2,3,
  5. Emmanuelle Filippi4,
  6. Isabelle Coudert5,
  7. Jean Philippe Hacot6,
  8. Martine Gilard7,8,
  9. Philippe Castellant7,8,
  10. Antoine Rialan9,
  11. Régis Delaunay10,
  12. Gilles Rouault11,
  13. Philippe Druelles12,
  14. Bertrand Boulanger13,
  15. Josiane Treuil14,
  16. Bertrand Avez15,
  17. Marc Bedossa1,2,3,
  18. Dominique Boulmier1,2,3,
  19. Marielle Le Guellec1,2,3,
  20. Jean-Claude Daubert1,2,3,
  21. Hervé Le Breton1,2,3
  1. 1CHU Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes, France
  2. 2Université de Rennes 1, LTSI, Rennes, France
  3. 3INSERM, U1099, Rennes, France
  4. 4CH de Vannes, Service de Cardiologie, Vannes, France
  5. 5CH de Saint-Brieuc, SAMU, Saint Brieuc, France
  6. 6CH de Lorient, Service de Cardiologie, Lorient, France
  7. 7Département de Cardiologie, CHU de Brest, Brest, France
  8. 8EA4324, Optimisation des Régulations Physiologiques (ORPhy), UFR Sciences et Techniques, Brest, France
  9. 9CH de Saint Malo, Service de Cardiologie, Saint Malo, France
  10. 10CH de Saint Brieuc, Service de Cardiologie, Saint Brieuc, France
  11. 11CH de Quimper, Service de Cardiologie, Quimper, France
  12. 12Clinique Saint Laurent, Service de Cardiologie, Rennes, France
  13. 13CH de Vannes, SAMU, Vannes, France
  14. 14CHU de Brest, SAMU, Brest, France
  15. 15CHU de Rennes, Service des Urgences médicales, Rennes, France
  1. Correspondence to Dr Vincent Auffret, Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2 rue Henri Le Guilloux, Rennes 35000, France; v.auffret{at}gmail.com

Abstract

Background High-degree atrioventricular block (HAVB) is a common complication of ST segment elevation myocardial infarction (STEMI). HAVB in STEMI is historically considered as a marker of worse outcome but overall data about HAVB in the contemporary era of mechanical reperfusion and potent antiplatelet therapies are scarce.

Aim Analysing incidence, clinical correlates and impact on inhospital outcomes of HAVB in a large prospective registry (Observatoire Régional Breton sur l'Infarctus, ORBI) of modern management of STEMI with a special focus on potential differences between patients with HAVB on admission and those who developed HAVB during hospitalisation.

Methods All patients enrolled in ORBI between June 2006 and December 2013 were included in the present analysis and were divided into 3 groups: patients without HAVB at any time, patients with HAVB on admission and those who developed HAVB during hospitalisation.

Results A total of 6662 patients (age: 62.0 (52.0–74.0) years; male: 76.3%) were included in the present analysis. HAVB was documented in 3.5% of patients, present on admission in 63.7% of patients and occurring during hospitalisation in 36.3%. Patients with HAVB on admission or occurring during the first 24 h of hospitalisation had higher inhospital mortality rates (18.1% and 28.6%, respectively) than patients without (4.5%) or with HAVB occurring beyond the first 24 h of hospitalisation (8.0%). However by multivariable analysis, HAVB was not independently associated with inhospital mortality contrarily to age, presentation as cardiac arrest, anterior STEMI location, reperfusion therapy, cardiogenic shock, mechanical ventilation and occurrence of sustained ventricular tachyarrhythmias or mechanical complication.

Conclusions Patients with HAVB had a higher mortality rate than patients without. However HAVB is not an independent predictor of inhospital mortality.

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