1 University Heart Center Hamburg, Germany.
2 German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany.
Eur Heart J Acute Cardiovasc Care. 2019 Mar;8(2):161-166. doi: 10.1177/2048872618809700. Epub 2018 Oct 26.
: The new European Society of Cardiology guideline for ST-segment elevation myocardial infarction recommends that left and right bundle branch block should be considered equal for recommending urgent angiography in patients with suspected myocardial infarction. We aimed to evaluate this novel recommendation in two prospective studies of patients with suspected myocardial infarction.
: We included 4067 patients presenting to the emergency department with suspected myocardial infarction. All patients had an ECG recorded immediately upon admission. Patients were classified as having right bundle branch block (RBBB), left bundle branch block (LBBB), bifascicular block (BFB) or no bundle branch block. All patients were followed for up to two years to assess mortality. In the overall population 125 (3.1%) patients had RBBB, 281 (6.9%) LBBB and 60 (1.5%) BFB. The final diagnosis of myocardial infarction was adjudicated in 20.8% (RBBB), 28.5% (LBBB), 23.3% (BFB) and 21.6% (no complete block) of patients. The mortality rate after one year was 10.7% (RBBB), 7% (LBBB), 17.5% (BFB) and 3.2% (no complete block). The adjusted hazard ratios were 1.29 (95% confidence interval (CI) 0.71-2.34; P=0.40) for RBBB, 1.71 (95% CI 1.17-2.50; P=0.006) for LBBB and 2.27 (95% CI 1.28-4.05; P=0.005) for BFB.
: Our results support the new European Society of Cardiology ST-segment elevation myocardial infarction guideline describing RBBB as a high risk for mortality in patients with suspected myocardial infarction. However, the data challenge the concept of RBBB as a trigger of acute angiography because the likelihood of myocardial infarction in a chest pain unit setting is equally frequent in patients without bundle branch block.
新的欧洲心脏病学会 ST 段抬高型心肌梗死指南建议，对于疑似心肌梗死的患者，左束支传导阻滞和右束支传导阻滞应同等推荐紧急血管造影。我们旨在通过两项疑似心肌梗死患者的前瞻性研究来评估这一新的推荐。
我们纳入了 4067 例因疑似心肌梗死而就诊于急诊科的患者。所有患者入院时均立即记录心电图。患者分为右束支传导阻滞（RBBB）、左束支传导阻滞（LBBB）、双束支阻滞（BFB）或无束支传导阻滞。所有患者均随访两年，以评估死亡率。在总人群中，125 例（3.1%）患者有 RBBB，281 例（6.9%）有 LBBB，60 例（1.5%）有 BFB。心肌梗死的最终诊断在 20.8%（RBBB）、28.5%（LBBB）、23.3%（BFB）和 21.6%（无完全阻滞）的患者中得到了证实。一年后的死亡率为 10.7%（RBBB）、7%（LBBB）、17.5%（BFB）和 3.2%（无完全阻滞）。调整后的危险比分别为 RBBB 1.29（95%置信区间 0.71-2.34；P=0.40），LBBB 1.71（95%置信区间 1.17-2.50；P=0.006）和 BFB 2.27（95%置信区间 1.28-4.05；P=0.005）。
我们的结果支持新的欧洲心脏病学会 ST 段抬高型心肌梗死指南，即 RBBB 描述为疑似心肌梗死患者死亡的高风险因素。然而，这些数据挑战了 RBBB 作为急性血管造影触发因素的概念，因为在胸痛单元环境中，无束支传导阻滞患者发生心肌梗死的可能性同样频繁。
