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Bundle branch block and acute myocardial infarction. Treatment and outcome
G Gunnarsson1, P Eriksson, M Dellborg
1Department of Medicine, Sahlgrenska University Hospital/Ostra, Göteborg, Sweden. gunnar.gunnarsson@sahlgrenska.se
Insights
Patients with bundle branch block (BBB) and suspected acute myocardial infarction (AMI) often receive suboptimal treatment. Improved diagnostic methods are crucial for identifying those with BBB and AMI who would benefit from thrombolytic therapy.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Bundle branch block (BBB) complicates the diagnosis of acute myocardial infarction (AMI).
- Early and accurate diagnosis is vital for timely intervention in suspected AMI cases.
Purpose of the Study:
- To investigate the early diagnosis, treatment patterns, and outcomes for patients presenting with BBB and clinically suspected AMI.
- To evaluate the effectiveness of current diagnostic and treatment strategies in this patient cohort.
Main Methods:
- A prospective, multicenter study involving 257 consecutive patients with BBB and suspected AMI across 14 Swedish coronary care units.
- Data collection focused on diagnostic findings, treatment administered (including thrombolysis), and patient outcomes.
Main Results:
- Left bundle branch block (LBBB) was observed in 62% and right bundle branch block (RBBB) in 38% of patients.
- Thrombolytic treatment rates differed significantly: 16% for LBBB and 36% for RBBB.
- A notable percentage of patients (20% with LBBB, 13% with RBBB) receiving thrombolysis did not have AMI.
- LBBB was associated with higher in-hospital mortality rates compared to RBBB.
Conclusions:
- Current treatment for patients with BBB and suspected AMI is often suboptimal.
- Enhanced diagnostic approaches are necessary to accurately identify AMI in patients with BBB, thereby optimizing eligibility for thrombolytic therapy.
Objective:
To study early diagnosis, treatment and outcome in patients with bundle branch block and clinically suspected acute myocardial infarction.
Design:
A prospective multicenter study including 14 Swedish coronary care units. The study included 257 consecutive patients with bundle branch block and clinical suspicion of acute myocardial infarction.
Results:
Left bundle branch block was present in 62% of patients and right bundle branch block in 38%. Thrombolytic treatment of acute myocardial infarction in the left and right bundle branch block was 16% and 36%, respectively. Of those undergoing thrombolytic therapy, 20% of patients with left and 13% with right bundle branch block did not develop an acute myocardial infarction. Patients with left bundle branch block had higher mortality rates than those with right bundle branch block. After one year there was no difference in mortality rates between patients with and those without acute myocardial infarction on admission.
Conclusion:
Patients with bundle branch block and suspected acute myocardial infarction receive suboptimal treatment. Thus better diagnostic regimes are needed to identify those patients with bundle branch block and acute myocardial infarction who are suitable for thrombolytic treatment.
