Author + information
- İlker Gül1,
- Ahmet Çağrı Aykan2,
- Tayyar Gökdeniz3,
- Faruk Boyacı4,
- Ezgi Kalaycıoğlu2,
- Engin Hatem2,
- Turhan Turan5,
- Mustafa Zungur1 and
- Şükrü Çelik2
Atrioventricular conduction blocks (AVCB) may occur after inferior wall ST elevation myocardial infarctions (I-STEMI). AVCB development increases mortality and morbidity rates. In this study, we aimed to evaluate the importance of clinical (GRACE) and angiographical (SYNTAX) scores in prediction of AVCB development.
339 patients admitted to our center with I-STEMI between August 2012-January 2013 were included in the study. The patients with a typical chest pain, having ST segment elevation of >1mm in ≥2 inferior leads (DII, DIII, aVF), and elevation in serum cardiac enzymes (CK-MB and Troponin-I) were defined as I-STEMI. The patients who had prior myocardial infarction, chronical lung or hepatic pathologies, with a history of cerebrovascular events and renal failure (cretinine >2.5 mg/dl) were not accepted in the study. Blood samples were obtained from laboratory results of the first reference period. All the patients were followed by 72 hours period admitted to our center with event recorder monitors. GRACE scores (GS) of the patients were calculated when they first admitted to the emergency service. SYNTAX score values were calculated with a computer programme (www.syntaxscore.com) according to the patients angiographic findings. The characteristics of AVCB patients were evaluated with statistical analysis.
The patients’ mean age was 64.2±12.1 and 260 of them were male. Patients with AVCB were older, and their heart rate and blood pressure means were lower at admission. Furthermore, creatinine levels, troponin index (troponin-ı / body surface area), SS and GS means were higher in AVCB patients. Complications and mortality rates were higher in AVCB patients (Table 1). Permanenet pacemaker implantation were performed on eleven patients during our study. According to the ROC and logistic regression analysis, it was determined that GS predicted AVCB development better than SS (Figure 1 and Table 2).
High degree of AVCB development after I-STEMI is nearly %15 of all cases. Event recorder monitoring is the best method to follow the I-STEMI patients in intensive care units. GS, one of the clinical scoring systems, predicts AVCB development better than SS, which is an angiographic scoring system. GS calculation might be useful in terms of prognasis after I-STEMI.
|AVCB (-)||AVCB (+)||p value|
|Systolic Blood Pressure (mmHg)||131.8±25.8||101.1±30.2||<0.001|
|Diastolic Blood Pressure (mmHg)||80.7±15.8||61.5±18.2||<0.001|
|Troponin Index (Troponin-I/Body surface area)||32.9±32.1||43.4±39.5||0.032|
|Blood Glucose (mg/dl)||146.9±65.9||160.4±94.5||0.050|
|Ejection Fraction (%)||46.3±7.2||42.6±8.9||0.001|
|Symptom-to-door time (hour)||4.32±4.0||4.76±4.57||0.466|
|Door-to-balloon time (minute)||21.7±6.1||21.3±5.9||0.600|
|Diabetes Mellitus (n=62)||49 (%17.4)||13 (%22.4)||0.357|
|Cardiogenic Shock (n=42)||25 (%8.9)||17 (%29.3)||<0.001|
|Mortality (n=20)||11 (%3.9)||9 (%15.5)||0.001|
|Ventricular Arrhythmias (n=46)||30 (%10.7)||16 (%27.6||0.001|
|Temporary Pacemaker (n=23)||12 (%4.3)||11 (%11)||<0.001|
|Permanent Pacemaker (n=11)||0||11 (%19)||0.001|
|İnferior+Right Ventricular STEMI (n=172)||134 (%47.7)||38 (%65.5)||0.001|
|GRACE score in hospital||148.5±37.8||185.9±49.7||<0.001|
|Balloon diameter (mm)||2.11±0.68||2.12±0.64||0.892|
|Stent diameter (mm)||3.02±0.77||3.14±0.70||0.345|
|Stent length (mm)||24.0±12.4||26.9±13.8||0.182|
|Tirofiban usage (n=51)||40 (%14.2)||11 (%19)||0.359|
|Drug Elauting Stent İmplantation (n=46)||42 (%14.9)||4 (%6.9)||0.103|
|Direct Stenting (n=53)||45 (%16)||8 (%13.8)||0.672|
|Thrombus Aspiration (n=25)||20 (%7.1)||5 (%8.6)||0.690|
|Coronary blood flow < TIMI III (n=63)||45 (%16)||18 (%31)||0.007|
AVCB; Atrioventricular conduction block, GFR; Glomerular Filtration Rate, STEMI; ST elevation myocardial infarction.
|Arrest on admission||,670||,693||,936||1||,333||1,954|
|Drug Eluting Stent||-,237||,429||,306||1||,580||,789|
|Right Coronary Artery||,501||,405||1,531||1||,145||1,650|
|SYNTAX Score >22||,602||,292||4,255||1||,039||1,825|
|GRACE score > 140||,834||,297||7,869||1||,005||2,303|
No-reflow phenomenon during primary percutaneous coronary intervention, GRACE score > 140 and SYNTAX score > 22 were the best predictors of atrioventricular conduction block development.