Prognostic Implications of Bundle Branch Block in Patients Undergoing Primary Coronary Angioplasty in the Stent Era

• Published in: The American journal of cardiology 2010-05, Vol.105 (9), p.1276-1283
• Main Authors: Vivas, David, MD, Pérez-Vizcayno, María Jose, MD, Hernández-Antolín, Rosana, MD, PhD, Fernández-Ortiz, Antonio, MD, PhD, Bañuelos, Camino, MD, Escaned, Javier, MD, PhD, Jiménez-Quevedo, Pilar, MD, PhD, De Agustín, Jose Alberto, MD, PhD, Núñez-Gil, Ivan, MD, PhD, González-Ferrer, Juan Jose, MD, Macaya, Carlos, MD, PhD, Alfonso, Fernando, MD, PhD
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty; Angioplasty, Balloon, Coronary - methods; Biological and medical sciences; Bundle-Branch Block - complications; Bundle-Branch Block - diagnosis; Bundle-Branch Block - mortality; Cardiac dysrhythmias; Cardiology; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Clinical outcomes; Coronary heart disease; Diseases of the cardiovascular system; Electrocardiography; Female; Follow-Up Studies; Heart; Heart attacks; Hospital Mortality - trends; Humans; Length of Stay; Male; Medical sciences; Middle Aged; Multivariate analysis; Myocardial Infarction - complications; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Prognosis; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Retrospective Studies; Risk Factors; Spain - epidemiology; Stents; Survival Rate - trends; Time Factors
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2009.12.044

The presence of bundle branch block (BBB) in patients with ST-segment elevation myocardial infarction has been associated with a poor outcome. However, the implications of BBB in patients undergoing primary angioplasty in the stent era are poorly established. Furthermore, the prognostic implications of BBB type (right vs left and previous vs transient or persistent) remain unknown. We analyzed the data from 913 consecutive patients with ST-segment elevation myocardial infarction treated with primary angioplasty. All clinical, electrocardiographic, and angiographic data were prospectively collected. The median follow-up period was 19 months. The primary end point was the combined outcome of death and reinfarction. BBB was documented in 140 patients (15%). Right BBB (RBBB) was present in 119 patients (13%) and was previous in 27 (23%), persistent in 45 (38%), and transient in 47 (39%). Left BBB (LBBB) was present in 21 patients (2%) and was previous in 8 (38%), persistent in 9 (43%), and transient in 4 (19%). Patients with BBB were older, and more frequently had diabetes, anterior infarctions, a greater Killip class, a lower left ventricular ejection fraction, and greater mortality (all p