Triage of Stable Patients With Suspected Acute Myocardial Infarction and Left Bundle Branch Block: A Multicenter,
Sascha Macherey-Meyer1, Sebastian Heyne, Max Maria Meertens
1University of Cologne, Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, Cologne, Germany; Cardiology III Angiology, Department of Cardiology, University Hospital, University of Mainz, Mainz, Germany; Department of Cardiology and Internal Intensive Care Medicine, Augustinerinnen Teaching Hospital, Cologne, Germany; Department of Medicine and Cardio-Diabetes Center Cologne, St. Antonius Hospital, Cologne, Germany; Cardiology and Internal Intensive Care Medicine, Protestant Hospital Köln-Kalk, Cologne, Germany; Department of Cardiology, Electrophysiology, and Rhythmology, Porz am Rhein Hospital gGmbH, Cologne, Germany; Internal Medicine III - Cardiology, St. Vinzenz Hospital, Cologne, Germany; Department of Medicine II, Cologne Municipal Hospitals gGmbH, Merheim Hospital, Cologne, Germany; Institute for Medical Statistics and Bioinformatics, Medical Faculty and University Hospital, University of Cologne, Germany.
Insights
Stable patients with Left Bundle Branch Block Acute Myocardial Infarction (LBBB-AMI) show similar outcomes to ST-segment Elevation Myocardial Infarction (STEMI) patients, with a high rate of acute culprit lesions. This supports routine emergency coronary angiography for LBBB-AMI.
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.
Background:
A pragmatic immediate invasive strategy is recommended in patients with ischemic symptoms and suspected left bundle branch block acute myocardial infarction (LBBB-AMI). It is important to identify patients with LBBB-AMI who do not need to be treated with the same strategy as those with ST-segment elevation myocardial infarction (STEMI). In this study, we aimed to compare the outcome of stable but symptomatic patients with suspected LBBB-AMI with that of matched STEMI patients.
Methods:
All consecutive patients who were referred for percu - taneous coronary intervention (PCI) in a metropolitan, multicenter STEMI network in Germany were analyzed and stratified according to their ECG findings (STEMI or LBBB). Propensity score matching (PSM) and adjusted analyses were performed.
Results:
4563 patients were included: 4219 (92.5%) with STEMI, and 344 (7.5%) with LBBB-AMI. After the identification of stable patients and PSM (n = 187 LBBB-AMI, n = 557 STEMI), the odds ratios for LBBB-AMI patients were 1.61 (95% confidence interval, [0.78; 3.32]) for in-hospital mortality, 0.56 [0.32; 0.91] for culprit lesion, and 2.18 [1.24; 3.84] for impaired patency of infarct-related artery after PCI. The median peak creatine kinase level was 1075 U/L in the STEMI patients and 478 U/L in the LBBB-AMI patients (estimated difference: -153 U/L [-504; 196]). Approximately, 70% of the LBBB-AMI patients had a culprit lesion in combination with myocardial necrosis implying acute stenosis.
Conclusion:
Approximately, seven of ten symptomatic LBBB-AMI patients had acute culprit lesions requiring timely PCI. The findings support routine emergency coronary angiography in these patients. Future prospective trials should address more selective triage.
More Related Videos
09:21Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations