Abstract 18831: Temporal Trends in Incidence, Utilization of Pacemaker, and Outcomes of Complete Heart Block in ST-Elevation Myocardial Infarction
Background: Cardiac conduction abnormalities are relatively common in acute ST-elevation myocardial infarction (STEMI). However there are limited data on the temporal trends in the incidence and outcomes of complete heart block (CHB) in patients with STEMI.
Methods: We used the 2003-2011 Nationwide Inpatient Sample databases to identify all patients >20 years of age hospitalized with a primary diagnosis of STEMI. Patients with prior history of pacemaker implantation, implantable cardioverter defibrillator, cardiac arrest or non-ischemic cardiomyopathy were excluded. Temporal trends were analyzed after adjusting for demographics, hospital characteristics and co-morbidities, using multivariable logistic regression.
Results: Of the 2,077,081 patients with STEMI from 2003-2011, 45,413 (2.2%) patients had CHB documented (mean age 68±13 years, 58.3% men, and 76% with inferior wall STEMI). In the cohort with CHB, 66.1% underwent percutaneous coronary intervention (PCI), 8.8% coronary artery bypass grafting (CABG), 14.1% permanent pacemaker (PPM) placement (19.4% in anterior and 11.9% in inferior STEMI), and 31.6% temporary pacemaker (TPM) placement. In-hospital mortality was 20.2% and median length of stay (LOS) was 4 days (IQR 6-8 days) in patients with CHB. Incidence of CHB in STEMI increased slightly from 2.1% in 2003 to 2.3% in 2011 (adjusted OR 1.03; 95% CI 1.02-1.03). PCI utilization in STEMI patients with CHB increased from 52.9% to 74.9% (adjusted OR 1.16; 95% CI 1.15-1.17) while CABG utilization decreased from 9.4% to 6.3% (adjusted OR 0.94; 95% CI 0.93-0.95). Utilization of PPM decreased from 16.7% to 13.5% (adjusted OR 0.98; 95% CI 0.97-0.99) while that of TPM non-significantly increased from 30.6% to 35.2% (adjusted OR 1.01; 95% CI 1.00-1.01; p=0.17). In-hospital mortality with CHB declined from 23% to 17.6% (adjusted OR 0.987; 95% CI 0.977-0.997) and the proportion of patients with LOS > 4 days decreased from 52.8% to 45.8% (adjusted OR 0.97; 95% CI 0.96-0.98).
Conclusions: From 2003-2011, we observed a slight increase in the incidence of CHB in STEMI patients. PCI utilization in STEMI patients with CHB increased while utilization of CABG and PPM decreased. In-hospital mortality and LOS also decreased during the study period in CHB patients.
Author Disclosures: P. Harikrishnan: None. D. Kolte: None. C. Palaniswamy: None. S. Khera: None. M. Mujib: None. W.S. Aronow: None. S. Iwai: Consultant/Advisory Board; Modest; Safety and Data Monitoring Board for BIOTRONIK. P. Eugenio: None. S. Lessner: None. S. Sule: None. D. Jain: None. A. Ahmed: None. G.C. Fonarow: None. D.L. Bhatt: None. H.A. Cooper: None. W.H. Frishman: None. J.A. Panza: None.
- © 2014 by American Heart Association, Inc.