Shinde Swapnil, Jadhav Nitin
Department of General Medicine, Krishna Institute of Medical Sciences University, Maharashtra, India.
Eurasian J Med. 2024 Oct 23;56(3):148-152. doi: 10.5152/eurasianjmed.2024.20164.
Conduction blocks complicating ST(ST-segment)-elevation myocardial infarction are associated with increased morbidity and mortality. Research indicates that anterior and inferior wall myocardial infarction were the most encountered causes of blocks but with conflicting results. However, patterns of conduction blocks have not been widely established in our population. The aim was to study the various patterns of conduction blocks following ST-elevation myocardial infarction and their prognostic implications. Prospectively, 70 patients, aged > 18 years, diagnosed with ST segment elevation myocardial infarction were included in the study. Post intensive care unit admission, all patients were observed for conduction blocks using a standard 12-lead electrocardiogram and repeated the same every 48 h throughout the hospitalization stay. Statistical analysis was performed using software R version 3.6.0. Out of 70 patients, 70% were males. Mean age was 60.7 ± 13.4 years. The proportion of blocks was first-degree heart block (28.6%), Mobitz II heart block (20%), complete heart block (17.1%), Mobitz I heart block (11.4%), right bundle branch block (10%), left bundle branch block (10%), left anterior hemiblock (1.4%), and trifascicular block (1.4%). No significant diference was found between males and females with respect to various conduction heart blocks (P > .05). Mortality was observed only in patients with complete heart block (11.4%) and first-degree heart block (2.8%; P = .003). Statistically, no significant diference was observed between various conduction blocks with respect to cardiac enzymes, random blood sugar, and lipid levels (P > .05). High mortality rate has been found in the patients with complete heart block indicating that severity of conduction block is a predictor of poor outcome in the ST-elevation myocardial infarction patients.
并发于ST段抬高型心肌梗死的传导阻滞与发病率和死亡率增加相关。研究表明，前壁和下壁心肌梗死是最常见的传导阻滞病因，但结果相互矛盾。然而，在我国人群中，传导阻滞的类型尚未得到广泛确立。本研究旨在探讨ST段抬高型心肌梗死后传导阻滞的各种类型及其预后意义。前瞻性纳入70例年龄>18岁、诊断为ST段抬高型心肌梗死的患者。入住重症监护病房后，所有患者均使用标准12导联心电图观察传导阻滞情况，并在整个住院期间每48小时重复检查一次。使用R 3.6.0版本软件进行统计分析。70例患者中，70%为男性。平均年龄为60.7±13.4岁。传导阻滞的比例依次为一度房室传导阻滞（28.6%）、莫氏Ⅱ型房室传导阻滞（20%）、完全性房室传导阻滞（17.1%）、莫氏Ⅰ型房室传导阻滞（11.4%）、右束支传导阻滞（10%）、左束支传导阻滞（10%）、左前分支传导阻滞（1.4%）和三分支传导阻滞（1.4%）。在各种传导性心脏阻滞方面，男性和女性之间未发现显著差异（P>.05）。仅在完全性房室传导阻滞患者（11.4%）和一度房室传导阻滞患者（2.8%；P =.003）中观察到死亡。在统计学上，各种传导阻滞在心肌酶、随机血糖和血脂水平方面未观察到显著差异（P>.05）。完全性房室传导阻滞患者的死亡率较高，表明传导阻滞的严重程度是ST段抬高型心肌梗死患者预后不良的一个预测指标。
