急性心肌梗死合并完全性束支传导阻滞的短期和长期预后重要性。

Short- and long-term prognostic importance of complete bundle-branch block complicating acute myocardial infarction.

作者信息

Dubois C, Piérard L A, Smeets J P, Foidart G, Legrand V, Kulbertus H E

机构信息

Department of Medicine, Section of Cardiology, University Hospital, Liège, Belgium.

出版信息

Clin Cardiol. 1988 May;11(5):292-6. doi: 10.1002/clc.4960110504.

DOI:10.1002/clc.4960110504

PMID:3383467

Abstract

Among 1013 consecutive patients with acute myocardial infarction (AMI), 104 (10%) developed complete bundle-branch block (BBB). The clinical characteristics and the short- and long-term prognosis were similar in the 53 patients with right and the 51 patients with left BBB. Compared to the 909 patients without this conduction disturbance, these 104 patients were older (64 +/- 9 vs. 58 +/- 10 years, p less than 0.001), more frequently women (26 vs. 17%, p less than 0.05), had a larger infarct (peak CK 1672 +/- 1124 vs. 1356 +/- 1089 IU/l, p less than 0.001), more frequently anterior (60 vs. 37%, p less than 0.001). They had a higher incidence of Killip class greater than 1 (63 vs. 38%, p less than 0.001), pericarditis (40 vs. 23%, p less than 0.001), atrial fibrillation or flutter (22 vs. 12%, p less than 0.01), ventricular fibrillation (15 vs. 9%, p less than 0.05), and atrioventricular block (23 vs. 11%, p less than 0.001). Both hospital mortality (32 vs 10%, p less than 0.001) and 3-year posthospital mortality (37 vs. 18%, p less than 0.001) were much higher among patients with complete BBB. Transient BBB had the same deleterious prognosis as BBB persistent at discharge (mortality 33 vs. 39%, NS). The prognostic importance of BBB was more prominent during the first 6 months after infarction (mortality between 6 and 36 months: 18% with BBB vs. 11% without BBB, NS).

摘要

在1013例连续的急性心肌梗死（AMI）患者中，104例（10%）发生了完全性束支传导阻滞（BBB）。53例右束支传导阻滞患者和51例左束支传导阻滞患者的临床特征以及短期和长期预后相似。与909例无此传导障碍的患者相比，这104例患者年龄更大（64±9岁对58±10岁，p<0.001），女性更常见（26%对17%，p<0.05），梗死面积更大（肌酸激酶峰值1672±1124对1356±1089 IU/L，p<0.001），前壁梗死更常见（60%对37%，p<0.001）。他们Killip分级大于1级的发生率更高（63%对38%，p<0.001），心包炎发生率更高（40%对23%，p<0.001），房颤或房扑发生率更高（22%对12%，p<0.01），室颤发生率更高（15%对9%，p<0.05），房室传导阻滞发生率更高（23%对11%，p<0.001）。完全性BBB患者的住院死亡率（32%对10%，p<0.001）和出院后3年死亡率（37%对18%，p<0.001）都高得多。短暂性BBB与出院时持续性BBB具有相同的不良预后（死亡率33%对39%，无显著性差异）。BBB的预后重要性在梗死后的前6个月更为突出（6至36个月的死亡率：有BBB者为18%，无BBB者为11%，无显著性差异）。