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Published on: December 11, 2017
Prognostic impact of left bundle-branch block in the early stable phase after acute myocardial infarction
Rüdiger Dissmann1, Wolfram Kamke, Rona Reibis
1Medizinische Klinik II (Kardiologie/Nephrologie) Klinikum Bremerhaven Reinkenheide, Postbrookstr. 103, D-27574 Bremerhaven, Germany.
Insights
Left bundle-branch block (LBBB) after myocardial infarction (MI) indicates a grave prognosis. This simple marker identifies high-risk patients who may benefit from interventions like defibrillator implantation.
Area of Science:
- Cardiology
- Clinical Medicine
- Medical Diagnostics
Background:
- Timely identification of high-risk patients post-acute myocardial infarction (MI) requires effective diagnostic markers.
- Assessing risk factors for mortality in stable, revascularized patients undergoing rehabilitation post-MI is crucial.
Purpose of the Study:
- To identify significant risk factors for death and sudden death in patients after acute myocardial infarction.
- To evaluate the prognostic value of Left Bundle-Branch Block (LBBB) in post-MI patients.
Main Methods:
- Prospective inclusion of 939 patients in an in-patient rehabilitation program post-MI.
- Collection of demographic, clinical data, ejection fraction (EF), Holter ECG, 12-lead ECG, and laboratory values.
- 18-month follow-up to assess outcomes.
Main Results:
- Left bundle-branch block (LBBB) was the most significant predictor of adverse outcomes (death, resuscitation, ventricular tachycardia), with a hazard ratio of 7.74.
- Patients with LBBB had a 42% mortality rate compared to 11.5% for those with left ventricular ejection fraction (EF) ≤30%.
Conclusions:
- LBBB during rehabilitation post-MI signifies a poor prognosis and high mortality, primarily from sudden death.
- Further research is needed to determine if LBBB identifies patients suitable for preventive defibrillator implantation or biventricular pacing.
Background:
Diagnostic marker parameters are needed to enable timely identification of high risk patients after acute myocardial infarction (MI). We assessed risk factors for death and sudden death in stable revascularized patients undergoing guideline-based therapy during an in-patient rehabilitation program more than 3 weeks after acute myocardial infarction.
Methods:
During an in-patient rehabilitation program, 939 patients with a recent myocardial infarction were prospectively included. Besides demographic and clinical data, ejection fraction (EF), Holter ECG, standard 12-lead electrocardiogram (ECG) and baseline laboratory values were determined. Patients were followed up for 18 months.
Results:
Among multiple variables, left bundle-branch block (LBBB) was the most significant parameter affecting the outcome (combination endpoint of death, resuscitation or ventricular tachycardia (VT)), hazard ratio 7.74 (3.2-18.7, P<0.0001). 42% of the 24 patients with LBBB but only 11.5% of the 62 patients with a left ventricular EF
Conclusion:
LBBB observed during a rehabilitation program following an acute MI indicates a grave prognosis with a high mortality rate (mainly caused by sudden death). Future studies are required to establish whether this simple marker characterizes a group of patients that will profit from preventive defibrillator implantation and/or biventricular pacing.
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