Management and outcome of patients with acute myocardial infarction presenting with pacemaker rhythm

• Published in: International journal of cardiology 2017-03, Vol.230, p.604-609
• Main Authors: Bertel, Noemi, Witassek, Fabienne, Puhan, Milo, Erne, Paul, Rickli, Hans, Naegeli, Barbara, Pedrazzini, Giovanni, Stauffer, Jean-Christophe, Radovanovic, Dragana
• Format: Article
• Language: English
• Subjects: Aged; Algorithms; AMIS Plus; Bundle-Branch Block - complications; Bundle-Branch Block - physiopathology; Bundle-Branch Block - therapy; Cardiovascular; Electrocardiography; Female; Follow-Up Studies; Heart Rate; Heart rhythm; Heart Ventricles - physiopathology; Hospital Mortality - trends; Humans; Male; Myocardial infarction; Myocardial Infarction - complications; Myocardial Infarction - mortality; Myocardial Infarction - surgery; Myocardial Revascularization - methods; Pacemaker; Pacemaker, Artificial; Propensity Score; Registries; Retrospective Studies; Risk Assessment - methods; Risk Factors; Sinus rhythm; Survival Rate - trends; Switzerland - epidemiology; Thrombolytic Therapy - methods
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2016.12.047

Abstract Background Diagnosis of acute myocardial infarction (MI) is challenging in pacemaker patients. Little is known about this patient group. Methods Patients with MI enrolled in the Swiss national AMIS Plus registry between January 2005 and December 2015 were analyzed. All patients with either paced ventricular rhythm or sinus rhythm with intrinsic ventricular conduction (IVC) were included in this study. Outcomes using crude data and propensity score matching were compared between patients with pacemaker rhythm and patients with IVC. The primary endpoint was in-hospital death. Results Data from 300 patients with paced rhythm and 27,595 with IVC were analyzed. Patients with pacemaker rhythm were older (78.2y vs 65.4y; p < 0.001), had more comorbidities (Charlson Index (CCI) > 1: 54.0% vs 21.1%; p < 0.001) and a higher rate of heart failure upon presentation (Killip class > 2, 11.0% vs 5.9%; p < 0.001) compared to patients with IVC. Door to balloon time in patients undergoing acute PCI is markedly delayed in contrast to patients with IVC (280 min vs 85 min; p < 0.001). Consequently, crude mortality in patients with pacemakers was high (11.3% vs 4.6%; p < 0.001). However, when analyzed with propensity matching for gender, age, CCI > 1 and Killip > 2, mortality was similar (11.2% vs 10.5%; p = 0.70). Conclusion Pacemaker patients with acute MI represent a high-risk group with doubled crude mortality compared to patients without pacemakers, due to higher age and higher Killip class. Diagnosis is difficult and results in delayed treatment. Treatment algorithms for MI with paced rhythm should possibly be adapted to those used for STEMI or new left bundle branch block.