Ozkalayci Flora, Turkyilmaz Erdem, Altıntaş Bernas, Akbal Ozgur Yasar, Karagoz Ali, Karabay Can Yucel, Tanboga İbrahim Halil, Oduncu Vecih
Hisar Intercontinental Hospital, Istanbul, Turkey.
Medical Faculty, Istinye University, İstanbul, Turkey.
Acta Cardiol. 2021 Aug;76(6):581-586. doi: 10.1080/00015385.2020.1747179. Epub 2020 Apr 14.
In this study we aim to determine and compare short term outcomes of all type bundle branch blocks (BBB) according to their onset time among those patients presented with ST-Segment elevation myocardial infarction (STEMI) and underwent primary percutaneous coronary intervention (pPCI).
Three thousand fifty-seven ST-segment elevation myocardial infarction patients who underwent pPCI were retrospectively evaluated. Those patients with BBB in their ECG on admission were re-evaluated for their prior ECG records. A composite of death, recurrent myocardial infarction (re-MI) and stroke in one moth follow up were defined as major adverse cardiovascular events (MACE).
Three thousand fifty-seven STEMI patients underwent pPCI were enrolled to the study. Among these patients 134 (4.4%) had LBBB, and 120 (3.9%) had RBBB. Bundle brunch block was classified according to the timing of their onset as follows; New or Presumably New BBB, Old BBB, Indeterminate Onset BBB. At one month, 4.8% of the patients died, 2.6% had re-MI/stent thrombosis, 0.5% had stroke. MACE occurred in 7.6% of patients. Left ventricle ejection fraction, BBB, estimated glomerular filtration rate (eGFR), shock and age were ranked as the strongest predictors of MACE. Compared to non-BBB, all BBBs except for old RBBB was found to be associated with increased MACE. New onset LBBB was the strongest predictor (OR:13.1, 95%CI:3.98-43.4, < .001) at one month MACE.
Compared to non-BBB, all BBBs except for old RBBB was found to be associated with increased MACE. New onset LBBB was the strongest predictor for MACE at one month.
在本研究中，我们旨在确定并比较所有类型束支传导阻滞（BBB）在出现ST段抬高型心肌梗死（STEMI）并接受直接经皮冠状动脉介入治疗（pPCI）的患者中，根据其发作时间的短期结局。
对3057例行pPCI的ST段抬高型心肌梗死患者进行回顾性评估。入院时心电图有BBB的患者重新评估其既往心电图记录。将1个月随访时的死亡、再发心肌梗死（re-MI）和中风的复合事件定义为主要不良心血管事件（MACE）。
3057例STEMI患者行pPCI纳入研究。这些患者中134例（4.4%）有左束支传导阻滞（LBBB），120例（3.9%）有右束支传导阻滞（RBBB）。束支传导阻滞根据其发作时间分类如下：新发或可能新发BBB、陈旧性BBB、发作时间不确定的BBB。1个月时，4.8%的患者死亡，2.6%有再发心肌梗死/支架血栓形成，0.5%有中风。7.6%的患者发生MACE。左心室射血分数、BBB、估计肾小球滤过率（eGFR）、休克和年龄被列为MACE的最强预测因素。与无BBB相比，除陈旧性RBBB外的所有BBB均与MACE增加相关。新发LBBB是1个月时MACE的最强预测因素（OR：13.1，95%CI：3.98 - 43.4，P <.001）。
与无BBB相比，除陈旧性RBBB外的所有BBB均与MACE增加相关。新发LBBB是1个月时MACE的最强预测因素。
