Abstract 17267: Outcomes of Patients With Non-ST-Segment Elevation Myocardial Infarction and High Degree Atrioventricular Block Treated With Early vs Delayed Invasive Strategy

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Introduction: High degree atrioventricular block (HDAVB) is an uncommon complication of non-ST-segment elevation myocardial infarction (NSTEMI), frequently necessitating pacemaker implantation. Hypothesis: This contemporary analysis compares the need for pacemaker implantation based on the timing of intervention in acute NSTEMI complicated by HDAVB. Methods: We used 2016-2017 National Inpatient Sample (NIS) database to identify all admissions with NSTEMI. Those without HDAVB were excluded from the study. Time to coronary intervention from initial admission was used to segregate the admissions into two groups: early invasive strategy (EIS) (<24 hours) and delayed invasive strategy (DIS)(>24 hours). A multivariate logistic and linear regression analysis was performed to compare in-hospital outcomes among both groups. Results: Out of 949,984 NSTEMI related admissions, coexistent HDAVB was present in 0.7% (n=6725) patients which were subsequently included in the study. Amongst those, 55.61% (n=3740) hospitalization included invasive intervention (EIS=1320, DIS=2420) (Figure1). Patients treated with EIS were younger (69.95 vs 72.38, p= <0.05) and had a concomitant cardiogenic shock. Contrarily the prevalence of chronic kidney disease (CKD), heart failure (HF), and pulmonary hypertension was higher in DIS group. EIS was associated with lower length of stay and total hospitalization cost. Although statistical significance was not achieved, a trend towards higher in-hospital mortality and lower pacemaker implantation rates were seen in hospitalizations involving EIS (Table1). Conclusions: HDAVB is a rare complication of NSTEMI and it is associated with significant mortality. The timing of revascularization does not appear to influence the rate of pacemaker placement in NSTEMI complicated by HDAVB. Further studies are needed to assess if all patients presenting with HDAVB should be treated with an early invasive strategy.