Complete Heart Block Still Raises Mortality in Myocardial Infarction Patients

Tanush Gupta, MD Interview with:
Tanush Gupta, MD
Chief Resident & Instructor of Medicine and

Prakash Harikrishnan, MD

Prakash Harikrishnan, MD
Fellow in Cardiology

New York Medical College at
Westchester Medical Center
Valhalla, NY


Medical Research: What is the background for this study?

Response: Complete heart block (CHB) is a relatively frequent complication in patients hospitalized with ST-elevation myocardial infarction (STEMI). Patients who develop complete heart block in the setting of STEMI have a 3- to 5-fold increase in in-hospital mortality compared to those without CHB. However, most of the existing reports on CHB complicating STEMI are from the pre-thrombolytic and thrombolytic era in the 1980s and 1990s, before the widespread use of percutaneous coronary intervention (PCI) and advent of modern adjunctive medical therapies.

Hence, the purpose of this investigation was to examine the association of complete heart block with in-hospital outcomes in patients hospitalized with STEMI and to examine the temporal trends in the incidence and outcomes of CHB complicating STEMI using the National Inpatient Sample (NIS) databases from 2003 to 2012.

Medical Research: What are the main findings?

Response: In this large nationwide study of approximately 2 million STEMI patients, we found the incidence of CHB to be 2.2%. Although there was a slight increase in incidence of CHB complicating STEMI over the 10-year study period, the absolute incidence of complete heart block in STEMI patients receiving contemporary management is quite low. We found that even in the current era of prompt reperfusion therapy, CHB remains associated with significantly higher in-hospital mortality. This was true both in patients with anterior and inferior STEMI, although the absolute risk excess was significantly higher in patients with anterior STEMI. In patients with  complete heart block complicating STEMI, although there were temporal declines in the need for permanent pacemaker (PPM) use, in-hospital mortality remained unchanged during the study period.

Medical Research: What should clinicians and patients take away from your report?

Response: Our findings concerning  complete heart block in this very large, unselected, nationwide, STEMI population probably represent the definitive analyses in this area. Clinicians have some important observational points to learn from our study relating to contemporary incidence and outcomes of complete heart block complicating STEMI. The single most important finding of the study, in our opinion, is that despite marked improvements in the management of acute coronary syndromes over the last several years, in-hospital mortality associated with CHB has not declined.

Medical Research: What recommendations do you have for future research as a result of this study?

Response:  Future investigations should focus on developing strategies to improve outcomes in patients with STEMI complicated by  complete heart block. In the meantime, early reperfusion and adjunctive medical therapies for STEMI aimed at attenuating ischemic injury should be aggressively pursued because these could potentially affect the incidence of and outcomes associated with complete heart block.


Harikrishnan P*, Gupta T*, Palaniswamy C, Kolte D, Khera S, Mujib M, Aronow WS, Ahn C, Sule S, Jain D, Ahmed A, Cooper HA, Jacobson J, Iwai S, Frishman WH, Bhatt DL, Fonarow GC, Panza JA. Complete heart block complicating ST-elevation myocardial infarction: temporal trends and association with in-hospital outcomes. J Am Coll Cardiol EP 2015:1;529-538. (*Co-first Authored)

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Tanush Gupta, MD, & Prakash Harikrishnan, MD (2016). Complete Heart Block Still Raises Mortality in Heart Attack Patients