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CLINICAL STUDIES

Complete atrioventricular block complicating acute myocardial infarction in the thrombolytic era

David Harpaz, MD^*, Solomon Behar, MD, Shmuel Gottlieb, MD, Valentina Boyko, MSc, Yehezkiel Kishon, MD^*, Michael Eldar, MD, FACC for the SPRINT Study Group the Israeli Thrombolytic Survey Group

^* Heart Institute, E. Wolfson Medical Center, Holon, Israel
Neufeld Cardiac Research Institute, Chaim Sheba Medical Center, Tel-Hashomer, Israel
Secondary Prevention Reinfarction Israeli Nifedipine Trial (SPRINT) research group centers and investigators, Israel
Israeli Thrombolytic Survey Group centers and investigators are listed in the Appendices, Israel

Manuscript received August 26, 1998; revised manuscript received June 17, 1999, accepted August 18, 1999.

Reprint requests and correspondence: David Harpaz, The Heart Institute, E. Wolfson Medical Center, Holon, 58-100 Israel
dharecho{at}netvision.net.il

OBJECTIVES

We assessed the incidence, associated clinical parameters and prognostic significance of complete atrioventricular block (CAVB) complicating acute myocardial infarction (AMI) in the thrombolytic era and compared them to data from the prethrombolytic era.

BACKGROUND

The introduction of new therapeutic modalities to treat AMI, aimed to enhance coronary reperfusion and to limit myocardial necrosis, was expected to decrease the incidence of CAVB and to improve prognosis. However, there are only limited data regarding the incidence and the prognosis of AMI patients with CAVB in the thrombolytic era.

METHODS

Data from 3,300 patients from the Israeli Thrombolytic Surveys (prospective, nationwide surveys of consecutive patients with AMI in all 25 coronary-care units in Israel in 1992 and 1996) were analyzed and compared with data from 5,788 patients included in the SPRINT (Secondary Prevention Reinfarction Israeli Nifedipine Trial) Registry (1981 to 1983).

RESULTS

During the 1990s, the incidence of CAVB was 3.7% compared with 5.3% in the 1980s, p = 0.0007. In the 1990s, mortality of patients with CAVB was significantly higher than in those without CAVB at 7 days (odds ratio [OR] = 4.05 95% CI [confidence interval] 2.34 to 6.82, 30 days OR = 3.98 [95% CI 2.44 to 6.43] and one-year hazard ratio [HR] = 2.36, [95% CI 1.68 to 3.30]) and similar in thrombolysis-treated and not-treated patients. Mortality of patients with CAVB has not changed significantly between the two periods; seven-day OR = 0.82 (95% CI 0.46 to 1.43); 30-day OR = 0.78 (95% CI 0.45 to 1.33) and one-year HR = 0.79 (95% CI 0.54 to 1.56), respectively, in the 1990s as compared to a decade earlier.

CONCLUSIONS

The incidence of CAVB complicating AMI is lower in the thrombolytic era than in the prethrombolytic era. Mortality among patients with CAVB is still high and has not declined within the last decade. The AMI patients who develop CAVB in the thrombolytic era have significantly worse prognosis than do patients without CAVB.

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   AMI = acute myocardial infarction   CAVB = complete atrioventricular block   CCU = coronary care unit   CI = confidence interval   CK = creatine kinase   HR = hazard ratio   OR = odds ratio   PTCA = percutaneous transluminal coronary angioplasty   RR = relative risk   SPRINT = Secondary Prevention Reinfarction Israeli Nifedipine Trial   TAMI = Thrombolysis and Angioplasty in Myocardial Infarction   TIMI = Thrombolysis in Myocardial Infarction trial

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