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

Noemi Bertel, Fabienne Witassek, Milo Puhan, Paul Erne, Hans Rickli, Barbara Naegeli, Giovanni Pedrazzini, Jean Christophe Stauffer, Dragana Radovanovic

Research output: Contribution to journalArticle

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 (78.2 y vs 65.4 y; 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. Clinical Trials Registration: NCT01305785.

Original languageEnglish (US)
Pages (from-to)604-609
Number of pages6
JournalInternational Journal of Cardiology
Volume230
DOIs
StatePublished - Mar 1 2017
Externally publishedYes

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Myocardial Infarction
Propensity Score
Bundle-Branch Block
Mortality
Registries
Clinical Trials
Therapeutics

Keywords

  • AMIS Plus
  • Heart rhythm
  • Myocardial infarction
  • Pacemaker
  • Sinus rhythm

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine

Cite this

Management and outcome of patients with acute myocardial infarction presenting with pacemaker rhythm. / Bertel, Noemi; Witassek, Fabienne; Puhan, Milo; Erne, Paul; Rickli, Hans; Naegeli, Barbara; Pedrazzini, Giovanni; Stauffer, Jean Christophe; Radovanovic, Dragana.

In: International Journal of Cardiology, Vol. 230, 01.03.2017, p. 604-609.

Research output: Contribution to journalArticle

Bertel, N, Witassek, F, Puhan, M, Erne, P, Rickli, H, Naegeli, B, Pedrazzini, G, Stauffer, JC & Radovanovic, D 2017, 'Management and outcome of patients with acute myocardial infarction presenting with pacemaker rhythm', International Journal of Cardiology, vol. 230, pp. 604-609. https://doi.org/10.1016/j.ijcard.2016.12.047
Bertel, Noemi ; Witassek, Fabienne ; Puhan, Milo ; Erne, Paul ; Rickli, Hans ; Naegeli, Barbara ; Pedrazzini, Giovanni ; Stauffer, Jean Christophe ; Radovanovic, Dragana. / Management and outcome of patients with acute myocardial infarction presenting with pacemaker rhythm. In: International Journal of Cardiology. 2017 ; Vol. 230. pp. 604-609.
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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 (78.2 y vs 65.4 y; 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. Clinical Trials Registration: NCT01305785.",
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AU - Bertel, Noemi

AU - Witassek, Fabienne

AU - Puhan, Milo

AU - Erne, Paul

AU - Rickli, Hans

AU - Naegeli, Barbara

AU - Pedrazzini, Giovanni

AU - Stauffer, Jean Christophe

AU - Radovanovic, Dragana

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N2 - 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 (78.2 y vs 65.4 y; 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. Clinical Trials Registration: NCT01305785.

AB - 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 (78.2 y vs 65.4 y; 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. Clinical Trials Registration: NCT01305785.

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KW - Heart rhythm

KW - Myocardial infarction

KW - Pacemaker

KW - Sinus rhythm

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