Introduction And Objectives: Complete atrioventricular block (CAVB) during inferior acute myocardial infarction (AMI), characterizes a high-risk subgroup of patients. This study was designed to determine the incidence and meaning of CAVB associated with inferior AMI and their peculiarities in relation to thrombolytic therapy.
Methods: Prospective and multicenter, involving 605 patients consecutively admitted with inferior AMI. We studied clinical characteristics and complications occurring during hospitalization and one-year follow-up were monitored.
Results: CAVB was found in 57 (9.4%) patients and was more frequently associated with: right ventricular involvement (35% vs 10%; p < 0.001), higher indexes of infaret size: ST elevated ECG leads (4.67 +/- 1.67 vs 4.1 +/- 1.4; p < 0.01) and peak of creatinkinase (2,219 +/- 1,543 vs 1,589 +/- 1,203; p < 0.01). Patients with CAVB had a higher incidence of cardiogenic shock (14% vs 5%; p < 0.05) and in-hospital mortality (21% vs 8.7%). CAVB had an independent value for predicting in-hospital mortality (odds ratio 2.7, 95% confidence interval, 1.3-5.5). CAVB appeared more frequently in the first hour of evolution (91% vs 41%; p < 0.01); its duration was shorter than 6 hours in a higher ratio (80% vs 5%; p < 0.01), and in- hospital mortality was lower (8.5 vs 40.9%; p < 0.05), in patients receiving thrombolytic treatment compared with patients without this treatment.
Conclusions: CAVB is a relatively frequent complication of inferior AMI and is often associated with larger infarcts, high incidence of complications and mortality. Earlier appearance, shorter duration and fewer in-hospital mortalities seem to characterize those CAVBs occurring in patients treated with thrombolytics.
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