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- Title
Treatment of patients with myocardial infarction who present with a paced rhythm.
- Authors
Rathore, Saif S.; Weinfurt, Kevin P.; Gersh, Bernard J.; Oetgen, William J.; Schulman, Kevin A.; Solomon, Allen J.; Rathore, S S; Weinfurt, K P; Gersh, B J; Oetgen, W J; Schulman, K A; Solomon, A J
- Abstract
<bold>Background: </bold>A paced rhythm can mask the electrocardiographic features of an acute myocardial infarction, complicating timely recognition and treatment.<bold>Objective: </bold>To evaluate characteristics, treatment, and outcomes among patients presenting with paced rhythms during myocardial infarction.<bold>Design: </bold>Retrospective cohort study.<bold>Setting: </bold>U.S. acute care hospitals.<bold>Patients: </bold>102 249 Medicare beneficiaries at least 65 years of age who were treated for acute myocardial infarction between 1994 and 1996.<bold>Measurements: </bold>Provision of three treatments for acute myocardial infarction (emergent reperfusion, aspirin, and beta-blockers), death at 30 days, and long-term follow-up.<bold>Results: </bold>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 beta-blockers at admission (RR, 0.89 [CI, 0.82 to 0.96]). In addition, there was a trend toward decreased use of beta-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]).<bold>Conclusions: </bold>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.
- Subjects
UNITED States; MYOCARDIAL infarction; CARDIAC pacemakers; PATIENTS
- Publication
Annals of Internal Medicine, 2001, Vol 134, Issue 8, p644
- ISSN
0003-4819
- Publication type
journal article
- DOI
10.7326/0003-4819-134-8-200104170-00009