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High-degree atrioventricular block, asystole, and electro-mechanical dissociation complicating non-ST-segment elevation myocardial infarction.

Publication ,  Journal Article
Pokorney, SD; Radder, C; Schulte, PJ; Al-Khatib, SM; Tricocci, P; Van de Werf, F; James, SK; Cannon, CP; Armstrong, PW; White, HD; Califf, RM ...
Published in: Am Heart J
January 2016

UNLABELLED: Non-ST-segment myocardial infarction (NSTEMI) can be complicated by high-degree atrioventricular (AV) block, asystole, or electromechanical dissociation (EMD), but these events are not well characterized in the contemporary era. This analysis assesses the incidence of and factors associated with these dysrhythmias in acute NSTEMIs. METHODS: Patients with NSTEMI in the EARLY ACS, PLATO, and TRACER trials were included in the pooled cohort (N = 29,677). Logistic regression was used to identify factors associated with in-hospital high-degree AV block and asystole or EMD, and Kaplan-Meier methods were used to assess mortality. RESULTS: High-degree AV block occurred in 112 (0.4%) patients, asystole in 157 (0.5%), and EMD in 38 (0.1%). Pacemakers were inserted in 241 patients (0.8%) during the index hospitalization: 30 (12%) for AV block. Among patients with high-degree AV block, we observed more frequent right coronary artery lesions (47% vs 29%). Age, diabetes, lower heart rate, and lower blood pressure were associated with high-degree AV block. Higher Killip class, ST-segment depression, prior myocardial infarction, and peripheral vascular disease were most strongly associated with asystole or EMD. Ten-day unadjusted survival was 90% for patients with high-degree AV block and 43% for those with asystole or EMD. CONCLUSIONS: Although high-degree AV block, asystole, and EMD were infrequent complications of NSTEMI, they were associated with substantial short-term mortality. Only 1 in 8 pacemakers placed in NSTEMI patients during the acute hospitalization was for high-degree AV block.

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

January 2016

Volume

171

Issue

1

Start / End Page

25 / 32

Location

United States

Related Subject Headings

  • United States
  • Risk Factors
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Incidence
  • Humans
  • Hospital Mortality
  • Heart Arrest
  • Female
 

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Pokorney, S. D., Radder, C., Schulte, P. J., Al-Khatib, S. M., Tricocci, P., Van de Werf, F., … Piccini, J. P. (2016). High-degree atrioventricular block, asystole, and electro-mechanical dissociation complicating non-ST-segment elevation myocardial infarction. Am Heart J, 171(1), 25–32. https://doi.org/10.1016/j.ahj.2015.09.004
Pokorney, Sean D., Christina Radder, Phillip J. Schulte, Sana M. Al-Khatib, Pierluigi Tricocci, Frans Van de Werf, Stefan K. James, et al. “High-degree atrioventricular block, asystole, and electro-mechanical dissociation complicating non-ST-segment elevation myocardial infarction.Am Heart J 171, no. 1 (January 2016): 25–32. https://doi.org/10.1016/j.ahj.2015.09.004.
Pokorney SD, Radder C, Schulte PJ, Al-Khatib SM, Tricocci P, Van de Werf F, et al. High-degree atrioventricular block, asystole, and electro-mechanical dissociation complicating non-ST-segment elevation myocardial infarction. Am Heart J. 2016 Jan;171(1):25–32.
Pokorney, Sean D., et al. “High-degree atrioventricular block, asystole, and electro-mechanical dissociation complicating non-ST-segment elevation myocardial infarction.Am Heart J, vol. 171, no. 1, Jan. 2016, pp. 25–32. Pubmed, doi:10.1016/j.ahj.2015.09.004.
Pokorney SD, Radder C, Schulte PJ, Al-Khatib SM, Tricocci P, Van de Werf F, James SK, Cannon CP, Armstrong PW, White HD, Califf RM, Gibson CM, Giugliano RP, Wallentin L, Mahaffey KW, Harrington RA, Newby LK, Piccini JP. High-degree atrioventricular block, asystole, and electro-mechanical dissociation complicating non-ST-segment elevation myocardial infarction. Am Heart J. 2016 Jan;171(1):25–32.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

January 2016

Volume

171

Issue

1

Start / End Page

25 / 32

Location

United States

Related Subject Headings

  • United States
  • Risk Factors
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Incidence
  • Humans
  • Hospital Mortality
  • Heart Arrest
  • Female