Triage of Stable Patients With Suspected Acute Myocardial Infarction and Left Bundle Branch Block: A Multicenter,...

Area of Science:

• Cardiology
• Interventional Cardiology
• Acute Coronary Syndromes

Background:

• Left Bundle Branch Block Acute Myocardial Infarction (LBBB-AMI) management often follows ST-segment Elevation Myocardial Infarction (STEMI) protocols.
• Differentiating LBBB-AMI patients who require immediate invasive strategy is crucial.
• This study compares outcomes in stable LBBB-AMI patients versus matched STEMI patients.

Purpose of the Study:

• To compare the outcomes of stable, symptomatic patients with suspected LBBB-AMI to matched STEMI patients.
• To evaluate the need for immediate invasive strategies in LBBB-AMI.
• To identify specific characteristics of LBBB-AMI relevant to treatment decisions.

Main Methods:

• Analysis of consecutive patients undergoing percutaneous coronary intervention (PCI) in a German STEMI network.
• Stratification based on ECG findings: STEMI or LBBB.
• Propensity score matching (PSM) and adjusted analyses were performed on stable patients.

Main Results:

• Out of 4563 patients, 344 had LBBB-AMI and 4219 had STEMI.
• After PSM (187 LBBB-AMI, 557 STEMI), LBBB-AMI patients had higher odds of impaired infarct-related artery patency post-PCI (OR 2.18).
• Approximately 70% of LBBB-AMI patients presented with acute culprit lesions requiring intervention, with lower peak creatine kinase levels compared to STEMI.

Conclusions:

• Seven out of ten symptomatic LBBB-AMI patients have acute culprit lesions necessitating timely PCI.
• Findings support routine emergency coronary angiography for suspected LBBB-AMI.
• Further prospective trials are needed for more selective patient triage.