Influence of Second-and Third-Degree Heart Block on 30-Day Outcome Following Acute Myocardial Infarction in the Drug-Eluting Stent Era

Title
Influence of Second-and Third-Degree Heart Block on 30-Day Outcome Following Acute Myocardial Infarction in the Drug-Eluting Stent Era
Author(s)
김영조Hack-Lyoung Kim[Hack-Lyoung Kim]김상현[김상현]서재빈[서재빈]정우영[정우영]조주희[조주희]김명아[김명아]박경우[박경우]구본권[구본권]김효수[김효수]
Keywords
DEGREE ATRIOVENTRICULAR-BLOCK; CONDUCTION DISTURBANCES; THROMBOLYTIC THERAPY; PROGNOSTIC IMPLICATIONS; ARRHYTHMIAS; DEFECTS
Issue Date
201412
Publisher
EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC
Citation
AMERICAN JOURNAL OF CARDIOLOGY, v.114, no.11, pp.1658 - 1662
Abstract
This study was conducted to investigate the prognostic value of heart block among patients with acute myocardial infarction (AMI) treated with drug-eluting stents. A total of 13,862 patients with AMI, registered in the nation-wide AMI database from January 2005 to June 2013, were analyzed. Second- (Mobitz type I or II) and third-degree atrioventricular block were considered as heart block in this study. Thirty-day major adverse cardiac events (MACE) including all causes of death, recurrent myocardial infarction, and revascularization were evaluated. Percutaneous coronary intervention with implantation of drug-eluting stent was performed in 89.8% of the patients. Heart block occurred in 378 patients (2.7%). Thirty-day MACE occurred in 1,144 patients (8.2%). Patients with heart block showed worse clinical parameters at initial admission, and the presence of heart block was associated with 30-day MACE in univariate analyses. However, the prognostic impact of heart block was not significant after adjustment of potential confounders (p = 0.489). Among patients with heart block, patients with a culprit in the left anterior descending (LAD) coronary artery had worse clinical outcomes than those of patients with a culprit in the left circumflex or right coronary artery. LAD culprit was a significant risk factor for 30-day MACE even after controlling for confounders (odds ratio 5.28, 95% confidence interval 1.22 to 22.81,.p = 0.026). In conclusion, despite differences in clinical parameters at the initial admission, heart block was not an independent risk factor for 30-day MACE in adjusted analyses. However, a LAD culprit was an independent risk factor for 30-day MACE among patients with heart block. (C) 2014 Elsevier Inc. All rights reserved. (Am J Cardiol 2014;114:1658-1662)
URI
http://hdl.handle.net/YU.REPOSITORY/30321http://dx.doi.org/10.1016/j.amjcard.2014.08.038
ISSN
0002-9149
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의과대학 > 내과학교실 > Articles
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