Intraventricular conduction delays as a predictor of mortality in acute coronary syndromes
Roope Lahti1, Jani Rankinen1,2, Markku Eskola3
1Faculty of Medicine and Health Technology and Finnish Cardiovascular Research Center Tampere, Tampere University, Elämänaukio 1, P.O Box 2000, 33520 Tampere, Finland.
Insights
Intraventricular conduction delays, including right bundle branch block (RBBB), left bundle branch block (LBBB), and non-specific IVCD, increase cardiac mortality risk in acute coronary syndrome (ACS) patients. These ECG findings are crucial prognostic indicators in ACS.
Area of Science:
- Cardiology
- Electrocardiography
- Clinical Research
Background:
- Intraventricular conduction delays (IVCDs) are common electrocardiographic findings.
- Previous studies suggested non-specific intraventricular conduction delay (NIVCD) as a potential mortality risk factor.
- The prognostic significance of different IVCD types, including RBBB, LBBB, and NIVCD, in acute coronary syndrome (ACS) requires further investigation.
Purpose of the Study:
- To investigate the prognostic implications of right bundle branch block (RBBB), left bundle branch block (LBBB), and non-specific intraventricular conduction delay (NIVCD) in patients with acute coronary syndrome (ACS).
- To determine the association between these electrocardiographic findings and cardiac mortality in the ACS population.
Main Methods:
- Retrospective analysis of 9749 consecutive ACS patients who underwent coronary angiography.
- Electrocardiographic (ECG) recordings were analyzed for the presence of RBBB, LBBB, and NIVCD.
- Cardiac mortality data were obtained from the Finnish national register, with follow-up until December 2020; subdistribution hazard estimates (SDH) were used to analyze risks, accounting for competing events.
Main Results:
- Patients with IVCDs exhibited a higher proportion of cardiac mortality compared to those without IVCDs.
- In analyses adjusted for age and cardiac comorbidities, RBBB, LBBB, and NIVCD were all significantly associated with increased cardiac mortality.
- After further adjustment for left ventricular ejection fraction, RBBB and NIVCD remained significant independent predictors of cardiac mortality.
Conclusions:
- Right bundle branch block (RBBB), left bundle branch block (LBBB), and non-specific intraventricular conduction delay (NIVCD) are associated with elevated cardiac mortality in patients with acute coronary syndrome (ACS).
- These ECG abnormalities serve as important prognostic markers in the management of ACS patients.
Aims:
Initial proof suggests that a non-specific intraventricular conduction delay (NIVCD) is a risk factor for mortality. We explored the prognosis of intraventricular conduction delays (IVCD)-right bundle branch block (RBBB), left bundle branch block (LBBB), and the lesser-known NIVCD-in patients with acute coronary syndrome (ACS).
Methods And Results:
This is a retrospective registry analysis of 9749 consecutive ACS patients undergoing coronary angiography and with an electrocardiographic (ECG) recording available for analysis (2007-18). The primary outcome was cardiac mortality. Mortality and cause of death data (in ICD-10 format) were received from the Finnish national register with no losses to follow-up (until 31 December 2020). The risk associated with IVCDs was analysed by calculating subdistribution hazard estimates (SDH; deaths due to other causes being considered competing events). The mean age of the population was 68.3 years [standard deviation (Sd) 11.8]. The median follow-up time was 6.1 years [interquartile range (IQR) 3.3-9.4], during which 3156 patients died. Cardiac mortality was overrepresented among IVCD patients: 76.9% for NIVCD (n = 113/147), 67.6% for LBBB (n = 96/142), 55.7% for RBBB (n = 146/262), and 50.1% for patients with no IVCD (n = 1275/2545). In an analysis adjusted for age and cardiac comorbidities, the risk of cardiac mortality was significantly higher in all IVCD groups than among patients with no IVCD: SDH 1.37 (1.15-1.64, P < 0.0001) for RBBB, SDH 1.63 (1.31-2.03 P < 0.0001) for LBBB, and SDH 2.68 (2.19-3.27) for NIVCD. After adjusting the analysis with left ventricular ejection fraction, RBBB and NIVCD remained significant risk factors for cardiac mortality.
Conclusion:
RBBB, LBBB, and NIVCD were associated with higher cardiac mortality in ACS patients.
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