COMPARISON OF IN-HOSPITAL MORTALITY IN PATIENTS WITH INFERIOR WALL MYOCARDIAL INFARCTION WITH AND WITHOUT COMPLETE ATRIOVENTRICULAR BLOCK

Abstract

Background:
Inferior wall myocardial infarction (MI) is frequently complicated by atrioventricular (AV) block, particularly complete AV block (CAVB), which increases morbidity and mortality. Despite advances in reperfusion therapy, the incidence of CAVB in inferior MI remains high, and local data on its prognostic significance are limited.

Objective:
To determine the frequency of in-hospital mortality in patients with inferior wall MI and to compare outcomes between those with and without complete AV block.

Materials and Methods:

This descriptive study was conducted at the Department of Cardiology, Khyber Teaching Hospital, Peshawar, over a six-month period. A total of 120 patients aged 40–70 years with inferior wall MI were included. Clinical data, comorbidities, risk factors, and complications were documented. Patients were stratified into two groups based on presence or absence of complete AV block. All were managed according to standard protocols and followed until discharge. Data were analyzed using SPSS version 25, and chi-square test was applied to compare mortality outcomes.

Results:
The mean age was 56.4 ± 8.7 years, with 65.0% males and 35.0% females. Overweight and obesity were observed in 81.7% of patients, and 41.7% had hypertension, while 31.7% had diabetes mellitus. Smoking was reported in 33.3% of cases. Thrombolysis was performed in 70.0% of patients, and 15.0% required temporary pacemaker insertion. Complications included post-MI angina (13.3%), congestive cardiac failure (15.0%), ventricular arrhythmias (6.7%), and reinfarction (5.0%). Complete AV block was present in 25.0% of patients. Overall in-hospital mortality was 10.0%. Mortality was significantly higher in patients with CAVB (20.0%) compared to those without CAVB (6.7%) (p = 0.041).

Conclusion:
Complete atrioventricular block is a frequent complication of inferior wall MI and is associated with a nearly three-fold increase in in-hospital mortality. Early identification and timely intervention in high-risk patients may improve clinical outcomes.