Influence of High-Degree Atrioventricular Block on 30-Day Clinical Outcome Following Acute Myocardial Infarction in the Drug-Eluting Stent Era: Results From Nation-Wide Registry of Acute Myocardial Infarction

Introduction: This study was conducted to investigate the prognostic value of high-degree atrioventricular block (HDAVB) among patients with acute myocardial infarction (AMI) treated with DES. Methods: A total of 13,862 patients with AMI, registered in the nation-wide AMI database between January 2005 and June 2013, were analyzed. Second- (Mobitz type I or II) and third-degree atrioventricular block (AVB) were considered as HDAVB in this study. Thirty-day major adverse cardiac events (MACE) including all causes of death, recurrent myocardial infarction, and revascularization were evaluated. Results: Percutaneous coronary intervention with implantation of DES was performed in 89.8% of the patients. HDAVB occurred in 378 patients (2.7%). Thirty-day MACE occurred in 1,144 patients (8.2%). Patients with HDAVB showed worse clinical parameters at initial admission, and the presence of HDAVB was associated with 30-day MACE in univariate analyses. However, the prognostic impact of HDAVB was not significant after adjustment of potential confounders (p = 0.489). Among patients with HDAVB, 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, 1.22-22.81; p = 0.026). Conclusions: Despite differences in clinical parameters at the initial admission, HDAVB 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 HDAVB.