Juárez-Herrera Ursulo, Jerjes Sánchez Carlos, González-Pacheco Héctor, Martínez-Sánchez Carlos
Staff Coronary Care Unit of Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
Arch Cardiol Mex. 2010 Jul-Sep;80(3):154-8.
Compare in-hospital outcome in patients with ST-elevation myocardial infarction with right versus left bundle branch block.
RENASICA II, a national Mexican registry enrolled 8098 patients with final diagnosis of acute coronary syndrome secondary to ischemic heart disease. In 4555 STEMI patients, 545 had bundle branch block, 318 (58.3%) with right and 225 patients with left (41.6%). Both groups were compared in terms of in-hospital outcome through major cardiovascular adverse events; (cardiovascular death, recurrent ischemia and reinfarction). Multivariable analysis was performed to identify in-hospital mortality risk among right and left bundle branch block patients.
There were not statistical differences in both groups regarding baseline characteristics, time of ischemia, myocardial infarction location, ventricular dysfunction and reperfusion strategies. In-hospital outcome in bundle branch block group was characterized by a high incidence of major cardiovascular adverse events with a trend to higher mortality in patients with right bundle branch block (OR 1.70, CI 1.19 - 2.42, p < 0.003), compared to left bundle branch block patients.
In this sub-study right bundle branch block accompanying ST-elevation myocardial infarction of any location at emergency room presentation was an independent predictor of high in-hospital mortality.
比较合并右束支传导阻滞与左束支传导阻滞的ST段抬高型心肌梗死患者的院内结局。
RENASICA II是一项墨西哥全国性登记研究，纳入了8098例最终诊断为缺血性心脏病继发急性冠状动脉综合征的患者。在4555例ST段抬高型心肌梗死患者中，545例存在束支传导阻滞，其中318例（58.3%）为右束支传导阻滞，225例（41.6%）为左束支传导阻滞。通过主要心血管不良事件（心血管死亡、复发性缺血和再梗死）比较两组的院内结局。进行多变量分析以确定右束支传导阻滞和左束支传导阻滞患者的院内死亡风险。
两组在基线特征、缺血时间、心肌梗死部位、心室功能障碍和再灌注策略方面无统计学差异。束支传导阻滞组的院内结局特点是主要心血管不良事件发生率高，与左束支传导阻滞患者相比，右束支传导阻滞患者的死亡率有升高趋势（比值比1.70，可信区间1.19 - 2.42，p < 0.003）。
在本亚组研究中，急诊就诊时伴有任何部位ST段抬高型心肌梗死的右束支传导阻滞是院内高死亡率的独立预测因素。
