Introduction: As part of the WHO MONICA study clinical information was collected on 5,000 survivors of AMI in Perth, Western Australia (WA), between 1984 and 1994. The information was used to determine the use and outcomes of cardiac pacemakers after AMI.
Methods: The MONICA data was linked to the WA Data Linkage System to determine hospital admission and discharge data and deaths within WA.
Results: During follow-up to mid-2006 (maximum 21.3 years from registration)169 permanent pacemakers (PPM)were implanted in survivors (3.3%), the majority within 5 years of AMI. Patients in whom a PPM was implanted were older (mean 58.2 years vs 54.4 years), more likely to have a previous AMI, a history of heart failure or hypertension. In-hospital complications of heart failure and syncope and of cardiac arrest, AV block or arrhythmias and the use of a temporary pacing wire were associated with requirement for a pacemaker. A recurrent AMI or ischaemic heart disease event within 28-days were predictors of the need for a PPM. ST segment changes on the electrocardiographs were less important than the rhythm disturbances that resulted in Minnesota coding of ECGs as 'uncodeable'. Crude survival to 5 years was 95.3% for patients with a PPM and 87.2% for those without(p <0.001). Long-term unadjusted and adjusted cumulative survival was not worse for patients with a PPM.
Conclusions: 28-days survivors of AMI who require implantation of a PPM have good survival outcomes despite generally being older and having more complications at the time of AMI.