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Year : 2022  |  Volume : 11  |  Issue : 1  |  Page : 15-21

Incidence, predictors, and outcome of significant atrioventricular block in acute coronary syndrome − A study from major center in North-Eastern India

Department of Cardiology, Gauhati Medical College, Guwahati, Assam, India

Correspondence Address:
DM Cardiology Farhin Iqbal
DM (CARDIO), Department of Cardiology, Gauhati Medical College, Guwahati, Assam
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jcpc.jcpc_12_21

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Background: Indian studies on significant atrioventricular (AV) block in entire spectrum of acute coronary syndrome (ACS) and its relation with clinical outcome are limited. Aims: The aim of this study is to determine the incidence, clinical predictor, and outcome of significant AV block complicating entire spectrum of ACS. Methods: All patients presenting with ACS from June 2017 to December 2018 were included in the study. The study population was divided into case and control groups based on the presence of significant AV block, either at admission or during hospitalization. The baseline clinical characteristics, mode of presentation, clinical course in the hospital, treatments in hospital, and complications related to the ACS and its treatment were analyzed between case and control groups. The inhospital and 30 day outcome was also analyzed. Results: A total of 1001 patients with ACS were included. One hundred and twenty-five patients of ACS with significant AV block comprised the study population (cases) and the rest 876 patients with ACS without significant AV block comprised the control population. The overall incidence of significant AV block was 12.48%. Patients with significant AV block had higher incidence of diabetes (40% vs. 20.77%, P-0.001), hypertension (36.8% vs. 20.89%, P-0.002), and history of smoking (57.6% vs. 34.2%, P-0.0001). On clinical presentation, patients with significant AV block had lower mean heart rate and higher killip class. Inferior wall myocardial infarction (44.4% vs. 22.8%, P-0.0001) was higher in cases, whereas anterior wall myocardial infarction (25.6% vs. 43.3% P-0.001) and unstable angina (4% vs. 10.2%, P-0.02) were higher in controls. Percentage of patients undergoing temporary pacemaker implantation or percutaneous coronary intervention during hospitalization was higher in cases. At 30 days, mortality was significantly higher among cases (24% vs. 8.1%, P-0.0001). Conclusion: Our data represent the first reported study on significant AV block in entire spectrum of ACS in North-eastern India and has noted the high incidence of significant AV block in our population and is associated with a worse short-term outcome.

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