急性下壁心肌梗死合并高度房室传导阻滞患者预后分析

Prognosis of patients with complete atrioventricular block complicating acute inferior STEMI

目的分析急性下壁心肌梗死合并完全传导阻滞患者的临床预后。方法回顾分析2011年1月到2014年12月因急性下壁心肌梗死入院行急诊PCI术的患者142例。其中高度房室传导阻滞组70例,未发生高度房室传导阻滞者72例。记录患者的临床特征及冠脉影像学特征,入院到球囊扩张时间(D2B)及院内临床结果。结果两组间基线资料相同。与未发生传导阻滞组相比房室传导阻滞组CK-MB峰值增高(569±63U/L VS 789±78U/L,P<0.01),临时起搏器使用比例增高(51.4%VS 4.2%,P<0.01),靶病变为右冠比例(92.9%VS 79.2%,P=0.02)及低血压休克比例(61.4%VS 15.3%,P<0.01)显著增高。与未发生传导阻滞组相比房室传导阻滞组院内病死率显著增加(5.7%VS 0,P=0.04),且院内MACE发生率有增高的趋势。结论急性下壁心肌梗死合并完全传导阻滞患者心肌梗死面积大,低血压休克发生率高。患者虽然行急诊PCI术,但是院内死亡仍高于未发生完全房室传导阻滞患者。

Objective This study was designed to determine the clinical effect of primary percutaneous coronary intervention（ PCI） in patients with complete atrioventricular block complicating acute inferior STEMI. Methods We retrospectively evaluated 142 consecutive patients who diagnosed with STEMI involving the inferior wall; of these,70 patients had complete atrioventricular block. All patients received primary PCI. The baseline clinical characteristics,angiography characteristics and clinical outcomes were compared in patients with versus without complete atrioventricular block. Results The baseline clinical characteristics between the 2 groups were similar. Patients with complete atrioventricular block were more likely to present with peak CK-MB（ 569 ± 63 U / L VS 789 ± 78 U / L,P〈0. 01）,placement of a temporary pacemaker（ 51. 4% VS 4. 2%,P〈0. 01）,right coronary artery occlusion（ 92. 9% VS 79. 2%,P = 0. 02） and hypotension shock（ 61. 4% VS 15. 3%,P〈0. 01）. After primary PCI,CAVB was reversed in all patients. There was a trend that rate of major adverse cardiac events（ MACE） was higher,and in-hospital mortality rate was increased（ 5. 7% VS 0,P = 0. 04） in complete atrioventricular block group. Conclusion Acute inferior wall myocardial infarction patients with complete atrioventricular block was more myocardial infarction area and hypotension shock. Although patients underwent primary PCI,the in-hospital mortality rate was higher in complete atrioventricular block patients.