Clinical characteristics of acute ST segment elevation myocardial infarction patients with in-hospital high degree atrioventricular block occurrence

Cao Jianing; Liu Wenxian

doi:10.3760/cma.j.issn.1673-4777.2016.11.005

Abstract：Objective To analyze clinical characteristics of patients with acute ST segment elevation myocardial infarction(STEMI) with in-hospital high-degree atrioventricular block (HAVB) occurrence.Methods Totally 2 343 cases with STEMI from August 2011 to August 2013 were retrospectively analyzed.According to the occurrence of HAVB,all patients were divided into HAVB group(93 cases) and non-HAVB group(2 250 cases).Clinical data,coronary artery lesions,arhythmia occurrences and major clinical events were recorded,to analyzed the clinical charactcristics of patients with in-hospital HAVB.Results In HAVB group,age[(63 ± 12)years vs (58 ± 12)years,P ＜ 0.001],the proportion of Killip Ⅲ-Ⅳ [50.5％ (47/93) vs 14.0％ (314/2 250),P ＜ 0.001] and the proportion of inferior and right ventricular infarction[68.8％ (64/93) vs 22.7％ (510/2 250),P ＜0.001] were significantly higher than those in non-HAVB group;systolic blood pressure [(101 ± 25) mmHg vs (119 ± 34) mmHg,P ＜ 0.001],diastolic blood pressure[(62 ± 16) mmHg vs (73 ± 14) mmHg,P ＜ 0.001],estimated glomerular filtration rate [71.6 (49.5,95.3) ml/(min · 1.73 m2) vs 88.7 (71.3,107.6) ml/(min · 1.73 m2),P ＜ 0.001] and left ventricular ejection fractions [(51 ± 1 0) ％ vs (53 ± 13) ％,P =0.045] were significantly lower than those in non-HAVB group.For treatment,proportions of using diuretics,vasoactive drugs and intraaortic balloon counterpulsation in HAVB group were significantly higher than those in non-HAVB group [32.3％ (30/93) vs 17.4％ (389/2 250),31.2％ (29/93) vs 10.0％ (224/2 250),66.3％ (61/93) vs 23.3％ (521/2 250)] (all P ＜0.001).Incidences of cardiac shock and sustained ventricular tachycardia or ventficular fibrillation in HAVB group were significantly higher than those in non-HAVB group [38.7％ (36/93) vs 7.0％ (157/2 250),26.9％ (25/93) vs 7.0％ (158/2 250)] (P ＜ 0.001).In-hospital mortality had no significant difference between groups(P ＞ 0.05).Binomial logistic regression analysis showed that diabetes,Killip Ⅲ-Ⅳ,left ventricular ejection fraction,inferior and right ventricular infarctions and using vasoactive drugs were risk factors of in-hospital mortality in patients with HAVB (all P ＜ 0.05);emergency percutaneous coronary intervention and using angiotensin converting enzyme inhibitors/angiotensin Ⅱ receptor antagonists were protective factors of in-hospital mortality in HAVB patients (all P ＜ 0.05).Conclusions Myocardial infarctions are mainly acute inferior and right ventricular myocardial infarctions.Although in-hospital mortality shows no significant increase in HAVB patients,incidences of cardiac shock and sustained ventricular tachycardia or ventricular fibrillation significant increase.