Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain.
Am J Cardiol. 2010 May 1;105(9):1276-83. doi: 10.1016/j.amjcard.2009.12.044. Epub 2010 Mar 11.
The presence of bundle branch block (BBB) in patients with ST-segment elevation myocardial infarction has been associated with a poor outcome. However, the implications of BBB in patients undergoing primary angioplasty in the stent era are poorly established. Furthermore, the prognostic implications of BBB type (right vs left and previous vs transient or persistent) remain unknown. We analyzed the data from 913 consecutive patients with ST-segment elevation myocardial infarction treated with primary angioplasty. All clinical, electrocardiographic, and angiographic data were prospectively collected. The median follow-up period was 19 months. The primary end point was the combined outcome of death and reinfarction. BBB was documented in 140 patients (15%). Right BBB (RBBB) was present in 119 patients (13%) and was previous in 27 (23%), persistent in 45 (38%), and transient in 47 (39%). Left BBB (LBBB) was present in 21 patients (2%) and was previous in 8 (38%), persistent in 9 (43%), and transient in 4 (19%). Patients with BBB were older, and more frequently had diabetes, anterior infarctions, a greater Killip class, a lower left ventricular ejection fraction, and greater mortality (all p <0.005) than patients without BBB. The short- and long-term primary outcome occurred more frequently in patients with persistent RBBB/LBBB than in those with previous or transient RBBB/LBBB. On multivariate analysis, persistent RBBB/LBBB emerged as an independent predictor of death and reinfarction. In conclusion, in patients undergoing primary angioplasty in the stent era, BBB is associated with poor short- and long-term prognosis. This risk appears to be particularly high among patients with persistent BBB.
束支传导阻滞（BBB）在 ST 段抬高型心肌梗死患者中的存在与预后不良有关。然而，在支架时代接受直接经皮冠状动脉介入治疗（PCI）的患者中，BBB 的意义尚未明确。此外，BBB 类型（右束支阻滞与左束支阻滞，以及陈旧性与一过性或持续性）对预后的影响仍不清楚。我们分析了 913 例接受直接 PCI 治疗的 ST 段抬高型心肌梗死患者的资料。所有临床、心电图和血管造影数据均前瞻性收集。中位随访时间为 19 个月。主要终点是死亡和再梗死的联合终点。140 例患者（15%）存在 BBB。119 例患者（13%）存在右束支阻滞（RBBB），其中陈旧性 27 例（23%），持续性 45 例（38%），一过性 47 例（39%）。21 例患者（2%）存在左束支阻滞（LBBB），其中陈旧性 8 例（38%），持续性 9 例（43%），一过性 4 例（19%）。存在 BBB 的患者年龄较大，更常患有糖尿病、前壁梗死、较高的 Killip 分级、较低的左心室射血分数和更高的死亡率（所有 p<0.005）。与无 BBB 的患者相比，持续性 RBBB/LBBB 的患者更易发生短期和长期的主要结局。多变量分析显示，持续性 RBBB/LBBB 是死亡和再梗死的独立预测因素。总之，在支架时代接受直接 PCI 的患者中，BBB 与短期和长期预后不良相关。这种风险在持续性 BBB 患者中似乎特别高。
