Freedman R A, Alderman E L, Sheffield L T, Saporito M, Fisher L D
J Am Coll Cardiol. 1987 Jul;10(1):73-80. doi: 10.1016/s0735-1097(87)80162-6.
The onset of bundle branch block during acute myocardial infarction is indicative of ischemia in the distribution of the left anterior descending coronary artery. However, whether patients with chronic coronary artery disease and bundle branch block have a predominance of left anterior descending artery lesions is not known. Similarly, the prognostic implications of bundle branch block have been studied primarily in the setting of acute myocardial infarction, and the independent prognostic implications of bundle branch block in patients with chronic coronary artery disease are not known. The electrocardiograms (ECGs) of 15,609 patients with chronic coronary artery disease who underwent coronary and left ventricular angiography as part of the Coronary Artery Surgery Study (CASS) were reviewed, and 522 patients with bundle branch block were identified. Patients with bundle branch block had both more extensive coronary artery disease and worse left ventricular function than did patients without bundle branch block. However, no particular location of coronary artery stenosis or left ventricular wall motion abnormality predominated in patients with bundle branch block. During a follow-up period of 4.9 +/- 1.3 years, 2,386 patients died. Actuarial probability of mortality at 2 years in patients with left bundle branch block was more than five times that in patients without bundle branch block (p less than 0.0001), and in patients with right bundle branch block the mortality rate was approximately twice that in patients without bundle branch block (p less than 0.0001). Stepwise Cox regression analysis showed that left bundle branch block, but not right bundle branch block, was a strong predictor of mortality, independent of degree of heart failure, extent of coronary disease and other variables (p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)
急性心肌梗死期间束支传导阻滞的发生提示左前降支冠状动脉分布区域存在缺血。然而，慢性冠状动脉疾病合并束支传导阻滞的患者是否以左前降支动脉病变为主尚不清楚。同样，束支传导阻滞的预后意义主要在急性心肌梗死的背景下进行了研究，而其在慢性冠状动脉疾病患者中的独立预后意义尚不清楚。对作为冠状动脉外科研究（CASS）一部分接受冠状动脉和左心室造影的15609例慢性冠状动脉疾病患者的心电图进行了回顾，识别出522例束支传导阻滞患者。与无束支传导阻滞的患者相比，束支传导阻滞患者的冠状动脉疾病更广泛，左心室功能更差。然而，束支传导阻滞患者中冠状动脉狭窄或左心室壁运动异常并无特定的优势部位。在4.9±1.3年的随访期内，2386例患者死亡。左束支传导阻滞患者2年的精算死亡率是无束支传导阻滞患者的5倍多（p<0.0001），右束支传导阻滞患者的死亡率约为无束支传导阻滞患者的2倍（p<0.0001）。逐步Cox回归分析表明，独立于心力衰竭程度、冠状动脉疾病范围和其他变量，左束支传导阻滞而非右束支传导阻滞是死亡率的强预测因素（p<0.0001）。（摘要截断于250字）
