COMPARISON OF IN-HOSPITAL MORTALITY IN PATIENTS WITH ST ELEVATION MYOCARDIAL INFARCTION WITH AND WITHOUT 3RD DEGREE AV BLOCK

Abstract

Objectives: To determine the frequency of third degree atrioventricular blocks in patients with ST elevation myocardial infarction and to determine the association between In-Hospital Mortality in patients with ST-Elevation Myocardial Infarction (STEMI) and third degree AV Block.

Study Design: Comparative cross-sectional study.

Study Setting and Duration: Department of Cardiology, Armed forces institute of Cardiology& National Institute of Heart Diseases, Rawalpindi from June 2018-November 2018.

Material and Methods: This was a comparative cross-sectional study. Patients fulfilling selection criteria were enrolled in the study through Emergency of department of AFIC & NIHD, Rawalpindi after their Informed consent. Patients between the ages of 25-75 years of both genders presenting with STEMI admitted in cardiology wards were included in the study while patients with previous MI, PCI or CABG or patients already taking treatment for AV block were excluded from the study. All patients were admitted in wards and were followed-up. During hospital stay of 3 days, patients were evaluated through ECG for the detection of AV block and their thrombolysis history was also noted. Two groups will be formed; group-1 with 3rd degree AV block and group-2 without 3rd degree AV block. Patients were followed-up further in cardiology wards and in-hospital mortality of patients was noted. Data was entered and analysed using SPSS-23.

Results: A total of 334 patients were recruited in the study out of which 207 (61.9%) were male patients while 127(38.0%) were female patients. Mean age of the patients was 62 ± 7.9 years. Patients with anterior wall MI were 171 (51.1%), inferior wall MI 127 (38.0%) and lateral wall MI in 36 (10.7%) patients. Patients who developed complete heart block were 15(4.5%).Out of total sample size 286 (85.6%) were discharged while 48 (14.4%) expired. As far the comparison between groups are concerned, patients with inferior wall MI developed complete heart block more 9 (60.0%) as compared to anterior wall 3(20.0%) and lateral wall MI 3 (20.0%). Mortality was more in patients with anterior wall MI.

Conclusion: Complete heart block is a recognized complication in patients with STEMI and is associated with worse outcomes. Our study results showed that frequency of complete heart block in STEMI patients receiving contemporary management is quite low.