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[Myocardial Infarction at the Background of Left Bundle Branch Block in the RECORD-3 Registry - Management and
V D Duplyakov1, D A Erlikh2, B Z Dzhinibalaeva3
1State Budgetary Educational Institution, "Samara Regional Clinical Cardiology Center".
Insights
Left bundle branch block (LBBB) in myocardial infarction (MI) patients indicates worse outcomes. These patients are older, have reduced ejection fraction, and require more interventions like artificial pulmonary ventilation.
Area of Science:
- Cardiology
- Clinical Practice
- Electrocardiography
Background:
- Left bundle branch block (LBBB) is a common finding in patients with acute coronary syndromes.
- Its prognostic significance in the context of verified myocardial infarction (MI) in real-world clinical settings requires further elucidation.
Purpose of the Study:
- To investigate the prognostic value of left bundle branch block (LBBB) in patients diagnosed with myocardial infarction (MI).
- To assess the clinical characteristics and management differences in MI patients with and without LBBB.
Main Methods:
- Analysis of data from the RECORD-3 registry, including consecutive patients hospitalized for suspected acute coronary syndrome.
- Identification of patients with verified MI and assessment for the presence and duration of LBBB on admission ECG.
- Comparison of clinical features, prehospital treatments, and in-hospital interventions between MI patients with and without LBBB.
Main Results:
- Among 871 MI patients, 48 (5.5%) had LBBB.
- MI patients with LBBB were older, had a higher prevalence of prior MI and comorbidities, and presented with more symptoms of heart failure and dyspnea.
- LBBB patients exhibited a significantly lower mean ejection fraction (44% vs. 52%) and were less likely to receive reperfusion therapy, while more frequently requiring artificial pulmonary ventilation and temporary cardiac pacing.
Conclusions:
- Left bundle branch block in patients with myocardial infarction is associated with adverse clinical characteristics and poorer cardiac function.
- LBBB presence in MI patients correlates with increased need for advanced respiratory and cardiac support and reduced utilization of reperfusion strategies.
- The findings highlight the negative prognostic implications of LBBB in the setting of myocardial infarction within a real-world clinical practice.
Purpose:
To study prognostic value of left bundle brunch block (LBBB) in patients with verified myocardial infarction in real clinical practice.
Material And Methods:
This analysis has been based on data from the RECORD-3 registry. This registry enrolled consecutive patients hospitalized in participating centers with suspected acute coronary syndrome. Among 2368 included patients 91 (3.84%) had LBBB on admission ECG ("new" in 25 [27.4%], "old" in 28 [30.8%]), and of "undetermined duration" in 38 [41.8%]). Myocardial infarction (MI) was verified in 871 patients, 48 of them (5.5%) had LBBB.
Results:
MI patients with compared with those without LBBB were significantly older (70.5 vs. 64 years, p=0.011), more often had history of MI and cerebral catastrophes, effort angina, symptoms of chronic heart failure and renal pathology. Patients with LBBB twice more often complained of dyspnea/suffocation and had significantly lower mean ejection fraction (44 vs 52%, p=0.001). At prehospital stage, they less often received aspirin, clopidogrel, β-adrenoblockers. Patients with LBBB more often required artificial pulmonary ventilation (APV) and temporary cardiac pacing, and were less often subjected to reperfusion strategy (52.1 vs. 85%, p.