ADMISSION CLINICAL AND ELECTROCARDIOGRAPHIC CHARACTERISTICS PREDICTING IN-HOSPITAL DEVELOPMENT OF HIGH-DEGREE ATRIOVENTRICULAR-BLOCK IN INFERIOR WALL ACUTE MYOCARDIAL-INFARCTION

This study assessed the ability of simple clinical and electrocardiogr aphic variables routinely obtained on admission to identify patients w ho are at high risk of developing high-degree atrioventricular (AV) bl ock during hospitalization in 1,336 patients with inferior wall acute myocardial infarction (AMI), Patients were classified into 2 initial e lectrocardiographic patterns based on the J-point to R-wave amplitude ratio: pattern 1: those with J point/R wave <0.5 and pattern 2: patien ts with J point/R wave greater than or equal to 0.5 in greater than or equal to 2 leads of the inferior leads II, III, and aVF. High-degree AV block was found in 6.7% of patients (41 of 615) with pattern 1 vers us 11.8% of the patients (85 of 721) with pattern 2 on admission elect rocardiogram (p = 0.0008), Multivariate logistic regression analysis r evealed that the only variables found to be independently associated w ith high-degree AV block were female gender (odds ratio [OR] 1.48; 95% confidence interval [Cl] 0.98 to 2.23; p = 0.06); Killip class on adm ission greater than or equal to 2 (OR 2.24; Cl 1.43 to 3.51; p = 0.000 4); initial electrocardiographic pattern 2 versus pattern 1 (OR 1.82; Cl 1.22 to 2.21; p = 0.003); and absence of abnormal Q waves on admiss ion (OR yes vs no 0.68; Cl 0.44 to 1.05; p = 0.08), A simple electroca rdiographic sign (J point/R wave greater than or equal to 0.5 in great er than or equal to 2 leads) is a reliable predictor of the developmen t of advanced AV block among patients receiving thrombolytic therapy f or inferior wall AMI. (C) 1997 by Excerpta Medica, Inc.