Treatment of Patients with Myocardial Infarction Who Present with a Paced Rhythm
Publication: Annals of Internal Medicine
Volume 134, Number 8
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Abstract
Background:
A paced rhythm can mask the electrocardiographic features of an acute myocardial infarction, complicating timely recognition and treatment.
Objective:
To evaluate characteristics, treatment, and outcomes among patients presenting with paced rhythms during myocardial infarction.
Design:
Retrospective cohort study.
Setting:
U.S. acute care hospitals.
Patients:
102 249 Medicare beneficiaries at least 65 years of age who were treated for acute myocardial infarction between 1994 and 1996.
Measurements:
Provision of three treatments for acute myocardial infarction (emergent reperfusion, aspirin, and β-blockers), death at 30 days, and long-term follow-up.
Results:
1954 patients (1.9%) presented with paced rhythms during myocardial infarction. These patients were older; were predominantly male; and had higher rates of congestive heart failure, diabetes, and previous infarction. They were significantly less likely to receive emergent reperfusion (relative risk [RR], 0.27 [95% CI, 0.22 to 0.33]), aspirin (RR at admission, 0.91 [CI, 0.88 to 0.94]; RR at discharge, 0.87 [CI, 0.83 to 0.92]), and β-blockers at admission (RR, 0.89 [CI, 0.82 to 0.96]). In addition, there was a trend toward decreased use of β-blockers at discharge (RR, 0.91 [CI, 0.76 to 1.06]). Crude mortality rates were higher among patients with paced rhythms than among those without at 30 days (25.8% vs. 21.3%; P = 0.001) and at 1 year (47.1% vs. 36.1%; P = 0.001). Among patients with paced rhythms, risk for death at 30 days decreased after adjustment for illness severity and decreased use of therapy (RR, 1.03 [CI, 0.93 to 1.14]). Patients with paced rhythms remained at additional risk for long-term mortality (hazard ratio, 1.12 [CI, 1.06 to 1.18]).
Conclusions:
Patients with paced rhythms were less likely than those without to receive treatment for acute myocardial infarction and had poorer short- and long-term outcomes. However, this mortality risk diminished after adjustment for treatment. This suggests that improved recognition and treatment of myocardial infarction may improve outcomes, particularly in the short term.
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Information & Authors
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Published In
Annals of Internal Medicine
Volume 134 • Number 8 • 17 April 2001
Pages: 644 - 651
History
Published online: 17 April 2001
Published in issue: 17 April 2001
Keywords
Copyright
© 2001 American College of Physicians.
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Treatment of Patients with Myocardial Infarction Who Present with a Paced Rhythm. Ann Intern Med.2001;134:644-651. [Epub 17 April 2001]. doi:10.7326/0003-4819-134-8-200104170-00009
Treatment of Patients with Myocardial Infarction Who Present with a Paced Rhythm. Ann Intern Med.2001;134:644-651. [Epub 17 April 2001]. doi:10.7326/0003-4819-134-8-200104170-00009
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