左束支传导阻滞和疑似心肌梗死：分支阻滞的慢性程度重要吗？
Left bundle branch block and suspected myocardial infarction: does chronicity of the branch block matter?
机构信息
University Hospital, Örebro, Sweden.
出版信息
Eur Heart J Acute Cardiovasc Care. 2013 Jun;2(2):182-9. doi: 10.1177/2048872613483589.
BACKGROUND
Our aim was to investigate if patients with suspected myocardial infarction (MI) and a new or presumed new left bundle branch block (nLBBB) were treated according to the ESC reperfusion guidelines and to compare them with patients having a previously known LBBB (oLBBB). Furthermore, we investigated the prevalence of ST-segment concordance in this population.
METHODS
Retrospective data was collected from the Swedeheart registry for patients admitted to the cardiac care unit at Örebro University Hospital with LBBB and suspected MI during 2009 and 2010. The patients were divided in two age groups; <80 or ≥80 years and analysed for LBBB chronicity (nLBBB or oLBBB), MI, and reperfusion treatment. We also compared our data with the national Swedeheart database for 2009.
RESULTS
A total of 99 patients fulfilled the inclusion criteria. A diagnosis of MI was significantly more common in the group ≥80 years compared to the group <80 years (53.8 vs. 25%, p=0.007). The rate of MI was similar in the groups with nLBBB and oLBBB (33 and 37% respectively, p=0.912). Of the 36 patients with a final diagnosis of MI, only eight (22%) had nLBBB. Reperfusion treatment, defined as an acute coronary angiography with or without intervention, was significantly more often performed in patients with nLBBB compared to patients with oLBBB (42 vs. 8%, p<0.001). The rate of MI and reperfusion treatment did not differ between our institution and the Swedish national data. ST-concordance was present in only two cases, one of which did not suffer an MI.
CONCLUSIONS
The proportion of patients receiving reperfusion treatment was low, but higher in nLBBB, reflecting a partial adherence to the guidelines. We found no correlation between LBBB chronicity and MI. Furthermore, only a minority of the MIs occurred in patients with nLBBB. ST-concordance was found in only one of 36 MI cases, indicating lack of sensitivity for this test.
背景
本研究旨在探讨疑似心肌梗死（MI）合并新发或疑似左束支传导阻滞（nLBBB）患者是否遵循 ESC 再灌注指南进行治疗，并与存在陈旧性左束支传导阻滞（oLBBB）的患者进行比较。此外，我们还研究了该人群中 ST 段一致性的发生率。
方法
回顾性收集 2009 年至 2010 年期间因 LBBB 和疑似 MI 入住厄勒布鲁大学医院心脏监护病房的患者的瑞典心脏登记处数据。将患者分为<80 岁和≥80 岁两个年龄组，并分析 LBBB 的慢性程度（nLBBB 或 oLBBB）、MI 和再灌注治疗。我们还将我们的数据与 2009 年全国瑞典心脏数据库进行了比较。
结果
共纳入 99 例患者。≥80 岁组 MI 的诊断明显多于<80 岁组（53.8%比 25%，p=0.007）。nLBBB 组和 oLBBB 组 MI 的发生率相似（分别为 33%和 37%，p=0.912）。在 36 例最终诊断为 MI 的患者中，仅有 8 例（22%）为 nLBBB。与 oLBBB 患者相比，nLBBB 患者接受再灌注治疗（定义为急性冠状动脉造影术伴或不伴介入治疗）的比例明显更高（42%比 8%，p<0.001）。我们医院和瑞典全国数据之间的 MI 和再灌注治疗率没有差异。仅在两例中存在 ST 段一致性，其中一例未发生 MI。
结论
再灌注治疗的患者比例较低，但 nLBBB 患者的比例较高，反映了对指南的部分遵循。我们没有发现 LBBB 慢性程度与 MI 之间的相关性。此外，nLBBB 患者中仅少数发生 MI。在 36 例 MI 病例中，仅 1 例出现 ST 段一致性，表明该检测的敏感性不足。
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