The impact of the complete atrioventricular block on in-hospital and long-term mortality in patients treated with primary percutaneous coronary intervention

Lidija  Savić; Igor Mardovic; Milika Ašanin; Sanja Stanković; Gordana Krljanac

doi:10.2298/VSP210926004S

Lidija Savić University Clinical Center of Serbia, Emergency Hospital, Cardiology Clinic, Coronary Care Unit
Igor Mardovic University Clinical Center of Serbia, Emergency Hospital, Cardiology Clinic, Coronary Care Unit
Milika Ašanin University Clinical Center of Serbia, Emergency Hospital, Cardiology Clinic, Coronary Care Unit
Sanja Stanković University Clinical Center of Serbia, Emergency Hospital, Cardiology Clinic, Center for Medical Biochemistry, Belgrade, Serbia
Gordana Krljanac University Clinical Center of Serbia, Emergency Hospital, Cardiology Clinic, Coronary Care Unit

DOI: https://doi.org/10.2298/VSP210926004S

Ključne reči: srce, blok;, mortalitet;, perkutana koronarna intervencija;, prognoza;, infarkt miokarda sa st elevacijom

Sažetak

Uvod/Cilj. Uticaj kompletnog atrioventrikularnog (AV) bloka na dugoročnu prognozu bolesnika sa infarktom miokarda sa elevacijom ST segmenta (ST-elevation myocardial infarction – STEMI) nije utvrđen u potpunosti. Cilj rada bio je da se analiziraju incidenca i prognostički uticaj AV bloka na intrahospitalni mortalitet (IHM) i 6-godišnji mortalitet bolesnika sa STEMI, lečenih primarnom perkutanom koronarnom intervencijom. Metode. Studijom su bila obuhvaćena 3 044 konsekutivna bolesnika sa STEMI. Rezultat. Kompletan AV blok registrovan je kod 144 (4,73%) bolesnika samo pri prijemu u bolnicu; 125 (86,8%) bolesnika sa kompletnim AV blokom imalo je infarkt donjeg zida. Privremeni pejsmejker ugrađen je kod 72 (50%) bolesnika sa kompletnim AV blokom. Stalni pejsmejker nije ugrađen ni jednom bolesniku. Kod bolesnika sa kompletnim AV blokom, IHM je bio značajno viši u poređenju sa IHM bolesnika bez kompletnog AV bloka: 17,9% vs. 3,6%, p < 0,001. Kod bolesnika sa infarktom donjeg zida i kompletnim AV blokom IHM je iznosio 13%, dok je kod bolesnika sa infarktom prednjeg zida i kompletnim AV blokom IHM iznosio 53%. Analizom rezultata bolesnika otpuštenih iz bolnice, utvrđen je značajno viši dugoročni (6-godšnji) mortalitet kod bolesnika sa kompletnim AV blokom u poređenju sa bolesnicima bez AV bloka: 7,8% vs. 3,4%, p < 0,001. Kompletan AV blok bio je nezavisan prediktor IHM i dugoročnog, 6-godišnjeg mortaliteta: IHM [odds ratio (OR) 2,94 95%, confidence interval (CI) 1,23–5,22; 6-godišnji mortalitet hazard ratio (HR) 1,61, 95%, CI 1,10–2,37]. Dodatnom analizom je utvrđeno da je kod bolesnika sa infarktom donjeg zida kompletan AV blok bio nezavisan prediktor IHM i 6-godišnjeg mortaliteta, dok je kod bolesnika sa infarktom prednjeg zida kompletan AV blok bio nezavisan prediktor samo IHM. Zaključak. Kod analiziranih bolesnika sa STEMI, kompletan AV blok bio je prolazan i registrovan je samo pri prijemu u bolnicu. Iako tranzitoran, kompletni AV blok bio je snažan nezavisni prediktor IHM i dugoročnog mortaliteta.

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Uticaj kompletnog atrioventrikularnog bloka na intrahospitalni i dugoročni mortalitet bolesnika lečenih primarnom perkutanom koronarnom intervencijom

Sažetak

Reference