Kleemann Thomas, Juenger Claus, Gitt Anselm Kai, Schiele Rudolf, Schneider Steffen, Senges Jochen, Darius Harald, Seidl Karlheinz
Herzzentrum Ludwigshafen, Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen, Germany.
Am Heart J. 2008 Aug;156(2):256-61. doi: 10.1016/j.ahj.2008.03.003. Epub 2008 Jun 20.
Both left bundle branch block and right bundle branch block (RBBB) have been associated with increased inhospital and long-term mortality in patients with acute ST elevation myocardial infarction (STEMI). However, the prognostic role of RBBB in acute non-ST elevation myocardial infarction (NSTEMI) is not well known. Therefore, the aim of the study was to evaluate the incidence and clinical impact of RBBB in patients with NSTEMI compared to patients with STEMI.
From the German prospective multicenter registry "Maximal Individual Therapy of Acute Myocardial Infarction" (MITRA PLUS), 6,403 consecutive patients with NSTEMI and 20,233 patients with STEMI were analyzed. Patients with left bundle branch block were excluded. The median follow-up time for NSTEMI was 378 days and for STEMI 479 days.
A total of 455 (7.1%) patients with NSTEMI and 894 (4.4%) patients with STEMI presented with RBBB on admission. In general, RBBB patients were older, more often had comorbidities, and less often received short-term inhospital treatment according to guidelines. In STEMI, RBBB patients had higher peak enzyme levels and lower left ventricular ejection fraction (LV-EF) than patients without BBB. Right bundle branch block in STEMI was associated with an increased inhospital and long-term mortality. In NSTEMI, however, peak enzyme levels and LV-EF were similar in both groups with and without RBBB. Right bundle branch block in NSTEMI was not independently associated with a worse outcome.
Unlike RBBB in STEMI, RBBB in NSTEMI is not an independent predictor of inhospital and long-term mortality.
左束支传导阻滞和右束支传导阻滞（RBBB）均与急性ST段抬高型心肌梗死（STEMI）患者住院期间及长期死亡率增加相关。然而，RBBB在急性非ST段抬高型心肌梗死（NSTEMI）中的预后作用尚不明确。因此，本研究旨在评估NSTEMI患者与STEMI患者相比RBBB的发生率及临床影响。
从德国前瞻性多中心注册研究“急性心肌梗死的最大个体化治疗”（MITRA PLUS）中，分析了6403例连续性NSTEMI患者和20233例STEMI患者。排除左束支传导阻滞患者。NSTEMI患者的中位随访时间为378天，STEMI患者为479天。
共有455例（7.1%）NSTEMI患者和894例（4.4%）STEMI患者入院时存在RBBB。总体而言，RBBB患者年龄更大，合并症更多，且较少按照指南接受短期住院治疗。在STEMI中，RBBB患者的酶峰值水平更高，左心室射血分数（LV-EF）低于无束支传导阻滞（BBB）的患者。STEMI中的右束支传导阻滞与住院期间及长期死亡率增加相关。然而，在NSTEMI中，有RBBB和无RBBB的两组患者酶峰值水平和LV-EF相似。NSTEMI中的右束支传导阻滞与较差预后无独立相关性。
与STEMI中的RBBB不同，NSTEMI中的RBBB并非住院期间及长期死亡率的独立预测因素。
