University of California, Davis Medical Center, Sacramento, USA.
Am J Cardiol. 2012 Feb 15;109(4):497-501. doi: 10.1016/j.amjcard.2011.09.040. Epub 2011 Dec 5.
Guidelines recommend urgent reperfusion for patients with new left bundle branch block (LBBB), similar to patients with ST-segment elevation myocardial infarction (STEMI). However, there are limited contemporary data comparing these 2 groups of patients. Patients presenting with acute STEMI or presumed new LBBB (nLBBB) enrolled in the Acute Coronary Treatment and Intervention Outcomes Network (ACTION) Registry-Get With the Guidelines (GWTG) from January 2007 to March 2009 were evaluated for clinical characteristics, treatment patterns, and outcomes. Logistic generalized estimating equation modeling was used to examine associated risk-adjusted mortality. Of 46,006 patients with either STEMI or nLBBB, 44,405 (96.5%) had STEMI, and 1,601 (3.5%) had nLBBB. Overall, patients with nLBBB had more baseline co-morbidities compared to those with STEMI. Compared to patients with STEMI, those with nLBBB were less likely to receive acute reperfusion (93.9% vs 48.3% p <0.0001) and were less likely to have door-to-balloon times ≤90 minutes (76.8% vs 34.5%, p <0.0001). Mortality rates were higher for patients with nLBBB compared to those with STEMI (13.3% vs 5.6%, p <0.0001). After multivariate adjustment, nLBBB was not associated with an increased risk for in-hospital mortality (odds ratio 0.91, 95% confidence interval 0.75 to 1.12, p = 0.38). In conclusion, patients with nLBBB were clinically different from those with STEMI, with significantly more co-morbidities, and were less likely to receive emergent reperfusion therapy. Despite these differences, adjusted mortality rates were similar between patients with nLBBB and those with STEMI.
指南建议对新发左束支传导阻滞（LBBB）患者进行紧急再灌注治疗，类似于 ST 段抬高型心肌梗死（STEMI）患者。然而，目前关于这两组患者的对照数据有限。从 2007 年 1 月至 2009 年 3 月，急性冠状动脉治疗和干预结果网络（ACTION）注册登记研究-遵循指南（GWTG）纳入了急性 STEMI 或疑似新发 LBBB（nLBBB）患者，对其临床特征、治疗模式和结局进行了评估。采用逻辑广义估计方程模型对相关风险调整死亡率进行了检验。在 46006 例 STEMI 或 nLBBB 患者中，44405 例（96.5%）为 STEMI，1601 例（3.5%）为 nLBBB。总体而言，nLBBB 患者的基线合并症较 STEMI 患者更多。与 STEMI 患者相比，nLBBB 患者接受急性再灌注治疗的可能性更低（93.9% vs 48.3%，p<0.0001），门球时间≤90 分钟的可能性更低（76.8% vs 34.5%，p<0.0001）。nLBBB 患者的死亡率较 STEMI 患者更高（13.3% vs 5.6%，p<0.0001）。多变量调整后，nLBBB 与住院期间死亡率增加无关（比值比 0.91，95%置信区间 0.75 至 1.12，p=0.38）。总之，nLBBB 患者与 STEMI 患者在临床方面存在显著差异，合并症更多，且更不可能接受紧急再灌注治疗。尽管存在这些差异，但 nLBBB 患者和 STEMI 患者的调整死亡率相似。
