Complete Heart Block Complicating ST-Segment Elevation Myocardial Infarction Temporal Trends and Association with In-Hospital Outcomes

Prakash Harikrishnan, Tanush Gupta, Chandrasekar Palaniswamy, Dhaval Kolte, Sahil Khera, Marjan Mujib, Wilbert S. Aronow, Chul Ahn, Sachin Sule, Diwakar Jain, Ali Ahmed, Howard A. Cooper, Jason Jacobson, Sei Iwai, William H. Frishman, Deepak L. Bhatt, Gregg C. Fonarow, Julio A. Panza

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Abstract

Objectives The purpose of this study was to determine the association of complete heart block (CHB) with outcomes and to examine temporal trends in the incidence and outcomes of CHB complicating ST-segment elevation myocardial infarction (STEMI). Background There are limited data available on the incidence and outcomes of CHB in STEMI patients who undergo contemporary management. Methods We used the 2003 to 2012 National Inpatient Sample databases to identify all patients age ≥18 years hospitalized with STEMI. Patients with a concomitant diagnosis of CHB were then identified. Multivariable logistic regression was used to analyze the association of CHB with outcomes and to examine the temporal trends in incidence and outcomes of CHB complicating STEMI. Results Of 2,273,853 patients with STEMI, 49,882 (2.2%) had CHB. The incidence of CHB increased from 2.1% in 2003 to 2.3% in 2012 (adjusted odds ratio [OR] per year: 1.02; 95% confidence interval [CI]: 1.02 to 1.03). STEMI patients with CHB had higher in-hospital mortality than those without CHB (20.4% vs. 8.7%; adjusted OR: 2.47; 95% CI: 2.41 to 2.53). The higher mortality associated with CHB was independent of the location of STEMI; however, the magnitude of this association was greatest in patients with anterior STEMI. In patients with CHB complicating STEMI, although permanent pacemaker implantation rates declined (adjusted OR per year: 0.96; 95% CI: 0.95 to 0.97), in-hospital mortality remained unchanged during the study period (adjusted OR per year: 1.00; 95% CI: 0.99 to 1.01). Conclusions The incidence of CHB complicating STEMI has increased slightly over the last decade, although the absolute incidence remains quite low. CHB remains associated with higher in-hospital mortality in STEMI patients even in the current era of prompt reperfusion therapy. In patients with CHB complicating STEMI, there was no change in risk-adjusted in-hospital mortality during the study period.

Original languageEnglish (US)
Pages (from-to)529-538
Number of pages10
JournalJACC: Clinical Electrophysiology
Volume1
Issue number6
DOIs
StatePublished - Dec 1 2015

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Heart Block
Myocardial Infarction
Hospital Mortality
Incidence
Odds Ratio
Confidence Intervals
ST Elevation Myocardial Infarction

Keywords

  • complete heart block
  • in-hospital mortality
  • pacemaker
  • ST-segment elevation myocardial infarction
  • trends

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Complete Heart Block Complicating ST-Segment Elevation Myocardial Infarction Temporal Trends and Association with In-Hospital Outcomes. / Harikrishnan, Prakash; Gupta, Tanush; Palaniswamy, Chandrasekar; Kolte, Dhaval; Khera, Sahil; Mujib, Marjan; Aronow, Wilbert S.; Ahn, Chul; Sule, Sachin; Jain, Diwakar; Ahmed, Ali; Cooper, Howard A.; Jacobson, Jason; Iwai, Sei; Frishman, William H.; Bhatt, Deepak L.; Fonarow, Gregg C.; Panza, Julio A.

In: JACC: Clinical Electrophysiology, Vol. 1, No. 6, 01.12.2015, p. 529-538.

Research output: Contribution to journalArticle

Harikrishnan, P, Gupta, T, Palaniswamy, C, Kolte, D, Khera, S, Mujib, M, Aronow, WS, Ahn, C, Sule, S, Jain, D, Ahmed, A, Cooper, HA, Jacobson, J, Iwai, S, Frishman, WH, Bhatt, DL, Fonarow, GC & Panza, JA 2015, 'Complete Heart Block Complicating ST-Segment Elevation Myocardial Infarction Temporal Trends and Association with In-Hospital Outcomes', JACC: Clinical Electrophysiology, vol. 1, no. 6, pp. 529-538. https://doi.org/10.1016/j.jacep.2015.08.007
Harikrishnan, Prakash ; Gupta, Tanush ; Palaniswamy, Chandrasekar ; Kolte, Dhaval ; Khera, Sahil ; Mujib, Marjan ; Aronow, Wilbert S. ; Ahn, Chul ; Sule, Sachin ; Jain, Diwakar ; Ahmed, Ali ; Cooper, Howard A. ; Jacobson, Jason ; Iwai, Sei ; Frishman, William H. ; Bhatt, Deepak L. ; Fonarow, Gregg C. ; Panza, Julio A. / Complete Heart Block Complicating ST-Segment Elevation Myocardial Infarction Temporal Trends and Association with In-Hospital Outcomes. In: JACC: Clinical Electrophysiology. 2015 ; Vol. 1, No. 6. pp. 529-538.
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abstract = "Objectives The purpose of this study was to determine the association of complete heart block (CHB) with outcomes and to examine temporal trends in the incidence and outcomes of CHB complicating ST-segment elevation myocardial infarction (STEMI). Background There are limited data available on the incidence and outcomes of CHB in STEMI patients who undergo contemporary management. Methods We used the 2003 to 2012 National Inpatient Sample databases to identify all patients age ≥18 years hospitalized with STEMI. Patients with a concomitant diagnosis of CHB were then identified. Multivariable logistic regression was used to analyze the association of CHB with outcomes and to examine the temporal trends in incidence and outcomes of CHB complicating STEMI. Results Of 2,273,853 patients with STEMI, 49,882 (2.2{\%}) had CHB. The incidence of CHB increased from 2.1{\%} in 2003 to 2.3{\%} in 2012 (adjusted odds ratio [OR] per year: 1.02; 95{\%} confidence interval [CI]: 1.02 to 1.03). STEMI patients with CHB had higher in-hospital mortality than those without CHB (20.4{\%} vs. 8.7{\%}; adjusted OR: 2.47; 95{\%} CI: 2.41 to 2.53). The higher mortality associated with CHB was independent of the location of STEMI; however, the magnitude of this association was greatest in patients with anterior STEMI. In patients with CHB complicating STEMI, although permanent pacemaker implantation rates declined (adjusted OR per year: 0.96; 95{\%} CI: 0.95 to 0.97), in-hospital mortality remained unchanged during the study period (adjusted OR per year: 1.00; 95{\%} CI: 0.99 to 1.01). Conclusions The incidence of CHB complicating STEMI has increased slightly over the last decade, although the absolute incidence remains quite low. CHB remains associated with higher in-hospital mortality in STEMI patients even in the current era of prompt reperfusion therapy. In patients with CHB complicating STEMI, there was no change in risk-adjusted in-hospital mortality during the study period.",
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author = "Prakash Harikrishnan and Tanush Gupta and Chandrasekar Palaniswamy and Dhaval Kolte and Sahil Khera and Marjan Mujib and Aronow, {Wilbert S.} and Chul Ahn and Sachin Sule and Diwakar Jain and Ali Ahmed and Cooper, {Howard A.} and Jason Jacobson and Sei Iwai and Frishman, {William H.} and Bhatt, {Deepak L.} and Fonarow, {Gregg C.} and Panza, {Julio A.}",
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T1 - Complete Heart Block Complicating ST-Segment Elevation Myocardial Infarction Temporal Trends and Association with In-Hospital Outcomes

AU - Harikrishnan, Prakash

AU - Gupta, Tanush

AU - Palaniswamy, Chandrasekar

AU - Kolte, Dhaval

AU - Khera, Sahil

AU - Mujib, Marjan

AU - Aronow, Wilbert S.

AU - Ahn, Chul

AU - Sule, Sachin

AU - Jain, Diwakar

AU - Ahmed, Ali

AU - Cooper, Howard A.

AU - Jacobson, Jason

AU - Iwai, Sei

AU - Frishman, William H.

AU - Bhatt, Deepak L.

AU - Fonarow, Gregg C.

AU - Panza, Julio A.

PY - 2015/12/1

Y1 - 2015/12/1

N2 - Objectives The purpose of this study was to determine the association of complete heart block (CHB) with outcomes and to examine temporal trends in the incidence and outcomes of CHB complicating ST-segment elevation myocardial infarction (STEMI). Background There are limited data available on the incidence and outcomes of CHB in STEMI patients who undergo contemporary management. Methods We used the 2003 to 2012 National Inpatient Sample databases to identify all patients age ≥18 years hospitalized with STEMI. Patients with a concomitant diagnosis of CHB were then identified. Multivariable logistic regression was used to analyze the association of CHB with outcomes and to examine the temporal trends in incidence and outcomes of CHB complicating STEMI. Results Of 2,273,853 patients with STEMI, 49,882 (2.2%) had CHB. The incidence of CHB increased from 2.1% in 2003 to 2.3% in 2012 (adjusted odds ratio [OR] per year: 1.02; 95% confidence interval [CI]: 1.02 to 1.03). STEMI patients with CHB had higher in-hospital mortality than those without CHB (20.4% vs. 8.7%; adjusted OR: 2.47; 95% CI: 2.41 to 2.53). The higher mortality associated with CHB was independent of the location of STEMI; however, the magnitude of this association was greatest in patients with anterior STEMI. In patients with CHB complicating STEMI, although permanent pacemaker implantation rates declined (adjusted OR per year: 0.96; 95% CI: 0.95 to 0.97), in-hospital mortality remained unchanged during the study period (adjusted OR per year: 1.00; 95% CI: 0.99 to 1.01). Conclusions The incidence of CHB complicating STEMI has increased slightly over the last decade, although the absolute incidence remains quite low. CHB remains associated with higher in-hospital mortality in STEMI patients even in the current era of prompt reperfusion therapy. In patients with CHB complicating STEMI, there was no change in risk-adjusted in-hospital mortality during the study period.

AB - Objectives The purpose of this study was to determine the association of complete heart block (CHB) with outcomes and to examine temporal trends in the incidence and outcomes of CHB complicating ST-segment elevation myocardial infarction (STEMI). Background There are limited data available on the incidence and outcomes of CHB in STEMI patients who undergo contemporary management. Methods We used the 2003 to 2012 National Inpatient Sample databases to identify all patients age ≥18 years hospitalized with STEMI. Patients with a concomitant diagnosis of CHB were then identified. Multivariable logistic regression was used to analyze the association of CHB with outcomes and to examine the temporal trends in incidence and outcomes of CHB complicating STEMI. Results Of 2,273,853 patients with STEMI, 49,882 (2.2%) had CHB. The incidence of CHB increased from 2.1% in 2003 to 2.3% in 2012 (adjusted odds ratio [OR] per year: 1.02; 95% confidence interval [CI]: 1.02 to 1.03). STEMI patients with CHB had higher in-hospital mortality than those without CHB (20.4% vs. 8.7%; adjusted OR: 2.47; 95% CI: 2.41 to 2.53). The higher mortality associated with CHB was independent of the location of STEMI; however, the magnitude of this association was greatest in patients with anterior STEMI. In patients with CHB complicating STEMI, although permanent pacemaker implantation rates declined (adjusted OR per year: 0.96; 95% CI: 0.95 to 0.97), in-hospital mortality remained unchanged during the study period (adjusted OR per year: 1.00; 95% CI: 0.99 to 1.01). Conclusions The incidence of CHB complicating STEMI has increased slightly over the last decade, although the absolute incidence remains quite low. CHB remains associated with higher in-hospital mortality in STEMI patients even in the current era of prompt reperfusion therapy. In patients with CHB complicating STEMI, there was no change in risk-adjusted in-hospital mortality during the study period.

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