Temporal trends of atrioventricular block in acute coronary syndrome patients from the ACSIS registry

Background: High-degree atrioventricular block (HDAVB) is a life-threatening complication among acute coronary syndrome (ACS). Objective: Our aim was to investigate temporal trends of the last two decades in incidence and prognosis of patients with HDAVB among patients who present with ACS. Methods: We evaluated 18,717 ACS patients from the multicenter ACSIS (Acute Coronary Syndrome Israeli Survey) registry. Temporal trends were examined in early (2000–2010) and late (2013–2021) periods. Results: Overall, HDAVB was diagnosed in 657 (3.5%) patients: 489 (4.25%) patients in the early period vs 168 (2.33%) in the late period (P < .001). Temporary pacemakers were implanted more frequently in the early vs the late period (59.4% vs 47%, P = .007), though implantation rate of permanent pacemakers was similar in both periods (11.3% vs 16.7%, P = .095). Patients with HDAVB from the late period experienced lower major adverse cardiovascular events (30.3% vs 43.8%, P = .003), 30-day mortality (18.9% vs 29.2%, P = .013) and 1-year mortality (26.1% vs 36.5%, P = .022). In multivariable analysis, admission Killip class >II (hazard ratio [HR] 2.85, P < .001), diabetes mellitus (HR 1.46, P = .01), and late period (vs early period, HR 1.44, P = .05) were independent predictors for 1-year mortality Conclusion: ACS patients with HDAVB experience elevated short- and long-term mortality rates overall. However, there is improvement in outcomes for this population throughout the years.