COMPLETE ATRIOVENTRICULAR-BLOCK COMPLICATING INFERIOR ACUTE WALL MYOCARDIAL-INFARCTION - SHORT-TERM AND LONG-TERM PROGNOSIS

The incidence of complete atrioventricular block (AVB) in a large grou p of patients with Q-wave inferior acute myocardial infarction (AMI) w as 251 (11%) of 2273 patients. This incidence was significantly higher in women (14%) and patients >70 years old (15%) than in men and patie nts <70 years old (10% and 9%, respectively). Patients with complete A VB exhibited more serious arrhythmic and mechanical complications duri ng hospitalization and included more patients with very high enzyme le vels than their counterparts without AVB. The in-hospital mortality ra te was 92 (37%) of 251 patients with complete AVB versus 200 (11%) of 1890 in those without AVB (p < 0.0001). After adjustment for age, gend er, and important anamnestic, medical, and enzymatic findings, complet e AVB emerged as an independent predictor of in-hospital mortality, yi elding an odds ratio of 2.0 (90% confidence interval 1.12 to 3.57). Th e long-term (5-year) mortality rate in hospital survivors was slightly but not significantly higher in patients with complete AVB (28%) duri ng hospitalization than in their counterparts with no AVB (23%). In vi ew of these data, patients with inferior AMI in whom complete AVB deve lops are at increased risk and may benefit from urgent revascularizati on; the postdischarge management of survivors with complete AVB should be no different from that of patients without AVB.