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Short- and long-term prognostic importance of complete bundle-branch block complicating acute myocardial infarction
C Dubois1, L A Piérard, J P Smeets
1Department of Medicine, Section of Cardiology, University Hospital, Liège, Belgium.
Insights
Acute myocardial infarction (AMI) patients developing complete bundle-branch block (BBB) were older, more frequently women, and had larger infarcts. Complete BBB significantly increases both hospital and 3-year mortality risk in AMI patients.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- Bundle-branch block (BBB) is a conduction disturbance that can occur during acute myocardial infarction (AMI).
- The prognostic implications of BBB in the context of AMI require further elucidation, particularly concerning differences between right and left BBB and the persistence of the block.
Purpose of the Study:
- To investigate the clinical characteristics and short- and long-term prognosis of patients who develop complete bundle-branch block (BBB) following acute myocardial infarction (AMI).
- To compare the outcomes of patients with and without BBB, and to assess the impact of BBB type (right vs. left) and persistence on mortality.
Main Methods:
- A retrospective analysis of 1013 consecutive patients with AMI was conducted.
- Patients were categorized based on the development of complete bundle-branch block (BBB) and type (right or left).
- Clinical data, infarct characteristics, and short-term (hospital) and long-term (3-year) mortality were compared between groups.
Main Results:
- 104 patients (10%) developed complete BBB, with similar characteristics and prognosis for right and left BBB.
- Patients with BBB were older, more frequently women, had larger infarcts, and higher incidence of complications like Killip class >1, pericarditis, and arrhythmias.
- Both hospital mortality (32% vs. 10%) and 3-year posthospital mortality (37% vs. 18%) were significantly higher in patients with BBB compared to those without.
Conclusions:
- Complete bundle-branch block (BBB) is associated with significantly worse clinical characteristics and a substantially higher risk of both short- and long-term mortality after acute myocardial infarction (AMI).
- The presence of BBB, regardless of type or persistence, portends a poorer prognosis, with the increased risk being most pronounced within the first six months post-infarction.
Abstract:
Among 1013 consecutive patients with acute myocardial infarction (AMI), 104 (10%) developed complete bundle-branch block (BBB). The clinical characteristics and the short- and long-term prognosis were similar in the 53 patients with right and the 51 patients with left BBB. Compared to the 909 patients without this conduction disturbance, these 104 patients were older (64 +/- 9 vs. 58 +/- 10 years, p less than 0.001), more frequently women (26 vs. 17%, p less than 0.05), had a larger infarct (peak CK 1672 +/- 1124 vs. 1356 +/- 1089 IU/l, p less than 0.001), more frequently anterior (60 vs. 37%, p less than 0.001). They had a higher incidence of Killip class greater than 1 (63 vs. 38%, p less than 0.001), pericarditis (40 vs. 23%, p less than 0.001), atrial fibrillation or flutter (22 vs. 12%, p less than 0.01), ventricular fibrillation (15 vs. 9%, p less than 0.05), and atrioventricular block (23 vs. 11%, p less than 0.001). Both hospital mortality (32 vs 10%, p less than 0.001) and 3-year posthospital mortality (37 vs. 18%, p less than 0.001) were much higher among patients with complete BBB. Transient BBB had the same deleterious prognosis as BBB persistent at discharge (mortality 33 vs. 39%, NS). The prognostic importance of BBB was more prominent during the first 6 months after infarction (mortality between 6 and 36 months: 18% with BBB vs. 11% without BBB, NS).