Velásquez-Rodríguez Jesús, Vicent Lourdes, Díez-Delhoyo Felipe, Valero Masa María Jesús, Bruña Vanesa, Sousa-Casasnovas Iago, Juárez-Fernández Miriam, Fernández-Avilés Francisco, Martínez-Sellés Manuel
Department of Cardiology, Hospital Universitario Severo Ochoa, 28914 Leganés, Spain.
Department of Cardiology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain.
J Clin Med. 2023 Jul 22;12(14):4834. doi: 10.3390/jcm12144834.
High-degree atrioventricular block (HAVB) is a known complication of ST-segment elevation myocardial infarction (STEMI). We aimed to determine the prevalence and prognostic impact of HAVB in a contemporary cohort of STEMI.
Data were collected from the DIAMANTE registry that included STEMI patients admitted to our cardiac intensive care unit treated with urgent reperfusion. We studied the clinical characteristics and evolution in patients with and without HAVB at admission.
From 1109 consecutive patients, HAVB was documented in 95 (8.6%). The right coronary artery was the culprit vessel in 84 patients with HAVB (88.4%). The independent predictors of HAVB were: male sex (OR 1.9, 95% CI 1.2-2.9), age (OR 1.03, 95% CI 1.01-1.05), involvement of right coronary artery (OR 12.4, 95% CI 7.6-20.2), and creatinine value (OR 1.5, 95% CI 1.1-2.0). A transient percutaneous pacemaker was used in 37 patients with HAVB (38.9%). Patients with HAVB had higher mortality that patients without HAVB (15.8% vs. 4.1%, < 0.001); however, in multivariate analysis, HAVB was not an independent predictor of in-hospital mortality.
HAVB was seen in 9% of STEMI patients and was particularly frequent in elderly males with renal failure. Patients with HAVB had a poor prognosis during hospitalization, but HAVB was not an independent predictor of in-hospital mortality.
高度房室传导阻滞（HAVB）是ST段抬高型心肌梗死（STEMI）的一种已知并发症。我们旨在确定当代STEMI队列中HAVB的患病率及其对预后的影响。
数据收集自DIAMANTE注册研究，该研究纳入了入住我们心脏重症监护病房并接受紧急再灌注治疗的STEMI患者。我们研究了入院时伴有和不伴有HAVB患者的临床特征及病情演变。
在1109例连续患者中，有95例（8.6%）记录有HAVB。84例HAVB患者（88.4%）的罪犯血管为右冠状动脉。HAVB的独立预测因素为：男性（比值比[OR]1.9，95%置信区间[CI]1.2 - 2.9）、年龄（OR 1.03，95% CI 1.01 - 1.05）、右冠状动脉受累（OR 12.4，95% CI 7.6 - 20.2）和肌酐值（OR 1.5，95% CI 1.1 - 2.0）。37例HAVB患者（38.9%）使用了临时经皮起搏器。伴有HAVB的患者死亡率高于无HAVB的患者（15.8%对4.1%，P < 0.001）；然而，在多变量分析中，HAVB并非院内死亡的独立预测因素。
9%的STEMI患者出现HAVB，在老年男性肾衰竭患者中尤为常见。伴有HAVB的患者住院期间预后较差，但HAVB并非院内死亡的独立预测因素。
