Impact of High-Degree Atrioventricular Block on No-Reflow Phenomenon and Prognosis in Patients with St-Segment Elevation Myocardial Infarction

Yıl 2018, Cilt: 21 Sayı: 2, 149 - 156, 19.08.2018

Metin Çağdaş Yavuz Karabağ

Öz

Introduction:
Although
it has been established that high-degree atrioventricular block (HAVB) is
associated with mortality in the course of ST segment elevation myocardial
infarction (STEMI), the mechanisms by which this AV block cause mortality are
not yet fully understood. In this study we aimed: (i) to investigate the
relationship between HAVB and no-reflow, which has been repeatedly shown to be
associated with both short- and long-term mortality; (ii) to determine the
effect of both HAVB and no-reflow on in-hospital and long-term mortality.

Patients
and Methods: A total of 1.217 patients who underwent primary
percutaneous coronary intervention (pPCI) were divided into two groups,
according to HAVB development, and were further divided according to no-reflow
development. Independent predictors of no-reflow were investigated.
Furthermore, patients were compared in terms of in-hospital and long-term
mortality. 

Results: In the
present study, 47 patients (3.8%) suffered from HAVB and 150 patients (12.3%)
had no-reflow. HAVB was an independent predictor of no-reflow [odds ratio (OR):
3.127, 95% confidence interval (CI): 1.215-9.056; p= 0.006]. In survival
analysis, both HAVB and no-reflow were associated with in-hospital (19.1% vs.
3.2%; p< 0.001 and 10.7% vs. 2.9%; p< 0.001, respectively) and long-term
(15.7% vs. 6.2%; p= 0.037 and 14.1% vs. 5.5%; p< 0.001, respectively)
mortality.

Conclusion: To our knowledge, this is
the first study in the literature to examine the effect of HAVB on reperfusion
success. In this study, we found that HAVB emerged with STEMI is
associated with long-term mortality and to short-term mortality. Also HAVB was
an independent predictor of no-reflow, and patients who had no-reflow had a
worse prognosis both in short- and long-term follow-up.

Anahtar Kelimeler

High grade AV block, ST segment elevation myocardial infarction, no-reflow

St-Segment Yükselmeli Miyokart İnfarktüslü Hastalarda Yüksek Dereceli Atriyoventriküler Bloğun No-reflow Fenomenine ve Prognoza Etkisi

Öz

Giriş: ST segment yükselmeli miyokart infarktüsü (STEMİ) seyrinde yüksek dereceli
atriyoventriküler bloğun (HAVB) mortalite ile ilişkili olduğu tespit edilmiş
olsa da AV bloğunun mortaliteye hangi mekanizmalarla neden olduğu, net olarak
ortaya konulmamıştır. Bu çalışmada, (i) HAVB ile hem kısa hem de uzun dönem
mortalite ile ilişkili olduğu defalarca gösterilen no-reflow arasındaki
ilişkiyi (ii) hem HAVB hem de no-reflow’un hastane içi ve uzun dönem
mortaliteye etkisini araştırmayı amaçladık.

Hastalar ve
Yöntem: Primer perkütan koroner girişim (pPCI) yapılan toplam
1217 hasta, HAVB gelişip gelişmemesine, daha sonra da no-reflow gelişip
gelişmemesine göre iki gruba ayrıldı. No-reflow’un bağımsız prediktörleri
araştırıldı. Son olarak da hastalar, hastane içi ve uzun dönem mortalite
açısından karşılaştırıldı.

Bulgular: Bu çalışmada, 47 (%3.8) hastada HAVB, 150 (%12.3) hastada no-reflow
izlendi. HAVB, no-reflow’un bağımsız bir prediktörü olarak saptandı (OR: 3.127,
%95 CI: 1.215-9.056; p= 0.006). Sağkalım analizinde HAVB ve no-reflow’da
hastane içi mortalite (sırasıyla %19.1’e karşı %3.2; p< 0.001 ve %10.7’ye
karşı %2.9; p< 0.001) ve uzun dönem mortalite (sırasıyla %15.7’ye karşı
%6.2; p= 0.037 ve %14.1’e karşı %5.5; p< 0.001) daha yüksek olarak izlendi.

Sonuç: Bu çalışmada, STEMİ ile
ortaya çıkan HAVB’nin, kısa döneme ek olarak, uzun dönem mortalite ile de
ilişkili olduğu tespit edildi. HAVB ile sağkalımla ileri derecede korelasyonu
olan reperfüzyon başarısının ilişkisini gösteren bu ilk çalışmada, HAVB’nin
no-reflow için bağımsız bir prediktör olduğunu ve no-reflow’u olan hastaların
hem kısa hem de uzun dönem izlemlerinde kötü prognoza sahip olduğunu ortaya
koyduk.

Anahtar Kelimeler

Yüksek dereceli atriyoventriküler blok, ST segment yükselmeli miyokart infarktüsü, no-reflow

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