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Updated: Jun 7, 2025

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疑似急性冠状动脉综合征的右束支部阻塞:诊断挑战,治疗和预后

Juliana Senftinger¹, Nils A Sörensen², Stefan Blankenberg²

¹Department of Cardiology, University Heart and Vascular Center Hamburg and Center for Population Health Innovation (POINT), Hamburg, Germany.

Journal of electrocardiology

|November 15, 2024

概括

右束分支块 (RBBB) 可能表明一般人群心血管风险增加. 在急性冠状动脉综合征 (ACS) 患者中,RBBB要求进行侵入性评估,即使没有典型的心电图变化,也可以识别潜在的ST升高心肌梗塞 (STEMI).

科学领域:

心脏病学心脏病学
电子生理学电子生理学
内部医学内部医学

背景情况:

在一般人群和急性冠状动脉综合征 (ACS) 患者中,对右捆分支块 (RBBB) 的预后意义存在相互矛盾的证据.
目前的指导方针将ACS中的RBBB视为STEMI等价物,但最近的研究表明需要进一步区分.
以前的研究通常将RBBB视为良性,但新出现的数据将其与心血管发病率和死亡率的增加联系起来.

研究的目的:

审查RBBB在一般人群和ACS患者的预后影响.
评估RBBB与心血管结果的关联,以及ST升高心肌梗塞 (STEMI) 的诊断准确性.
为了向临床实践提供有关RBBB的ACS患者的管理的信息.

主要方法:

在PubMed和谷歌学者中进行了文献搜索.
对先前关于RBBB患病率,相关死亡率和疑似ACS的血管学发现的研究分析.
在RBBB的存在下,对STEMI标准的诊断准确性的审查.

主要成果:

在一般人群中,RBBB与心血管发病率和死亡率的增加有关.
在疑似ACS中,RBBB的患病率为3%,与死亡率升高有关,与其他心电图呈现相比,罪祸首动脉识别率相似.
在高风险的ACS患者中,RBBB (12%的患病率) 与较差的结果相关,但STEMI诊断准确度不受影响;然而,许多没有明显STEMI症状的RBBB患者在血管学上有急性STEMI.

结论:

患有RBBB和一般人群中的风险因素的患者可能需要进一步进行心血管评估.
支持目前的指导方针,建议对具有RBBB的高风险ACS患者进行急性侵入性评估.
在未被选择的ACS患者中,RBBB需要考虑差异诊断,并且如果怀疑STEMI尽管没有特定的ECG发现,可能会立即接受心脏导管治疗.

关键词:

急性冠状动脉综合征是什么慢性冠状动脉综合征慢性冠状动脉综合征一般人口一般人口.RBBBBB RBBBBB RBBBBB RBBBBB RBBBBB RBBBBB RBBBBBBB RBBBBBBB RBBBBBBB RBBBBBBB RBBBBBBB RBBBBBBB RBBBBBBBBB RBBBBBBBBB RBBBBBBBBB RBBBBBBBBB RBBBBBBBBB RBBBBBBBBBBB

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