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Incidence, predictors, and outcomes of high-degree atrioventricular block complicating acute myocardial infarction treated with thrombolytic therapy.

Publication ,  Journal Article
Meine, TJ; Al-Khatib, SM; Alexander, JH; Granger, CB; White, HD; Kilaru, R; Williams, K; Ohman, EM; Topol, E; Califf, RM
Published in: Am Heart J
April 2005

BACKGROUND: In the fibrinolytic era, several studies have suggested that the rate of atrioventricular block (AVB) in the setting of acute myocardial infarction (MI) is high and is associated with increased short-term mortality. We sought to delineate predictors of AVB and determine long-term mortality of patients developing AVB in the setting of ST-segment elevation MI (STEMI) treated with thrombolytic therapy. METHODS: We combined data on patients from 4 similar studies of STEMI. We identified independent predictors of AVB and compared the 6-month and 1-year mortality rates of patients with AVB (5251) to the rates of patients without AVB (70 742). RESULTS: The incidence of AVB was 6.9%. Significant independent predictors of AVB included inferior MI, older age, worse Killip class at presentation, female sex, enrollment in the United States, current smoking, hypertension, and diabetes. Adjusted mortality was significantly higher in patients with AVB than in patients without AVB within 30 days (OR 3.2, 95% CI 2.7-3.7), 6 months (OR 1.6, 95% CI 1.5-1.8), and 1 year (OR 1.5, 95% CI 1.3-1.6). For patients with AVB and inferior MI, mortality odds ratios (ORs) were 2.2 (95% CI 1.7-2.7), 2.6 (95% CI 2.4-2.9), and 2.4 (95% CI 2.2-2.6) within 30 days, 6 months, and 1 year, respectively. For patients with AVB and anterior MI, mortality ORs were 3.0 (95% CI 2.2-4.1), 3.5 (95% CI 3.1-3.8), and 3.3 (95% CI 3.0-3.7) within 30 days, 6 months, and 1 year, respectively. CONCLUSIONS: In the thrombolytic era, AVB in the setting of STEMI is common and associated with higher mortality. Future studies should focus on determining therapies that are effective at reducing mortality rates in such patients.

Duke Scholars

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

April 2005

Volume

149

Issue

4

Start / End Page

670 / 674

Location

United States

Related Subject Headings

  • United States
  • Tissue Plasminogen Activator
  • Thrombolytic Therapy
  • Tenecteplase
  • Survival Analysis
  • Streptokinase
  • Risk Factors
  • Recombinant Proteins
  • Randomized Controlled Trials as Topic
  • Odds Ratio
 

Citation

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Meine, T. J., Al-Khatib, S. M., Alexander, J. H., Granger, C. B., White, H. D., Kilaru, R., … Califf, R. M. (2005). Incidence, predictors, and outcomes of high-degree atrioventricular block complicating acute myocardial infarction treated with thrombolytic therapy. Am Heart J, 149(4), 670–674. https://doi.org/10.1016/j.ahj.2004.07.035
Meine, Trip J., Sana M. Al-Khatib, John H. Alexander, Christopher B. Granger, Harvey D. White, Rakhi Kilaru, Kathryn Williams, E Magnus Ohman, Eric Topol, and Robert M. Califf. “Incidence, predictors, and outcomes of high-degree atrioventricular block complicating acute myocardial infarction treated with thrombolytic therapy.Am Heart J 149, no. 4 (April 2005): 670–74. https://doi.org/10.1016/j.ahj.2004.07.035.
Meine TJ, Al-Khatib SM, Alexander JH, Granger CB, White HD, Kilaru R, et al. Incidence, predictors, and outcomes of high-degree atrioventricular block complicating acute myocardial infarction treated with thrombolytic therapy. Am Heart J. 2005 Apr;149(4):670–4.
Meine, Trip J., et al. “Incidence, predictors, and outcomes of high-degree atrioventricular block complicating acute myocardial infarction treated with thrombolytic therapy.Am Heart J, vol. 149, no. 4, Apr. 2005, pp. 670–74. Pubmed, doi:10.1016/j.ahj.2004.07.035.
Meine TJ, Al-Khatib SM, Alexander JH, Granger CB, White HD, Kilaru R, Williams K, Ohman EM, Topol E, Califf RM. Incidence, predictors, and outcomes of high-degree atrioventricular block complicating acute myocardial infarction treated with thrombolytic therapy. Am Heart J. 2005 Apr;149(4):670–674.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

April 2005

Volume

149

Issue

4

Start / End Page

670 / 674

Location

United States

Related Subject Headings

  • United States
  • Tissue Plasminogen Activator
  • Thrombolytic Therapy
  • Tenecteplase
  • Survival Analysis
  • Streptokinase
  • Risk Factors
  • Recombinant Proteins
  • Randomized Controlled Trials as Topic
  • Odds Ratio