Complete heart blocks and in-hospital mortality after ST segment elevation myocardial infarction.

Abstract

Objective: To determine the frequency and in-hospital mortality of patients with complete heart blocks after STEMI. Study Design: Comparative Cross Sectional study. Study Setting: Department of Cardiology, Aziz Bhatti Shaheed Teaching Hospital, Nawaz Sharif Medical College, Gujrat. Period: January 2019 to December 2019. Material & Methods: Patients meeting selection criteria having age 35 to 65 of both genders with STEMI either thrombolysed or not were enrolled in the study  after their informed consent, whereas patients with prior history of MI, PCI or CABG or patients with prior AV blocks were excluded from the study. All patients remained admitted and followed up for 3 to 4 days. Patients were evaluated by ECG for diagnosis of AV blocks. Two groups were made, one with and second without complete heart blocks. Incidence and mortality of CHB after STEMI noted. Data was analyzed with SPSS -23. Results: Out of167 patients, 103(61.6%) male, while 64(38.4%) were female. Mean age was 50.5+10. Patients with AWMI 85 (50.8%), IWMI 63(37.7%) and LWMI were 18(10.77%). Ten (5.9%) developed CHB. Two groups were made on the basis of presence or absence of CHB. In first group 7 out of 10 having CHB were expired, 2 discharged and one referred for permanent pacemaker or revascularization. In second group 23 (15%) expired out of 157, 110(70%) discharged while 24(15%) were referred for invasive management. Patients having IWMI (60%) developed CHB more as compared to anterior (20%) or lateral wall MI (20%). Mortality due to CHB complicating STEMI was 4.19% while overall mortality was 17.96% (30). Conclusion: Complete heart block is a known complication of patients with STEMI and is associated with poor prognosis. Thrombolytic agents were very useful in patients with STEMI for reversal of CHB in most of the patients.