Yang Yi, Wang Jun, Wu Bing, Xu Yanan, Tang Long, Jiang Haibing, Wang Benfang, Zhu Tongjian
Department of Cardiology Fourth Ward, The Xinjiang Medical University Affiliated Hospital of Traditional Chinese Medicine, Urumqi, China.
Department of Cardiology, Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
Front Physiol. 2022 Aug 22;13:892623. doi: 10.3389/fphys.2022.892623. eCollection 2022.
The aim of the study was to evaluate the potential predictive value of permanent RBBB and LBBB for longer-term prognosis in patients with new-onset STEMI who underwent percutaneous coronary intervention (PCI). Patients with new-onset STEMI that underwent emergency PCI at our department from June 2012 to September 2020 were included in the study. Gensini score (GS) was employed to evaluate the severity of coronary lesions. The primary endpoint of the study was the occurrence of major adverse cardiac and cerebrovascular events (MACCEs), the composite of cardiac mortality, recurrence of myocardial infarction, cardiac shock, stroke, stent thrombosis, or revascularization. We also set all-cause mortality as a secondary endpoint. Out of the 547 patients, 29 patients had new-onset permanent LBBB, 51 patients had new-onset permanent RBBB, and 467 patients had no bundle-branch block (BBB). The occurrence of no BBB, new permanent LBBB, or RBBB was not associated with the severity of coronary artery lesions as evaluated by the GS. After follow-up at an average of 43.93 months, MACCEs occurred in 52 patients. Kaplan-Meier analysis showed that patients with new-onset RBBB were at greater risk for MACCEs compared to those with new onset LBBB (χ = 5.107, = 0.021). Also, an independent correlation was found between new permanent RBBB and LBBB and MACCEs risk. The adjusted hazard ratios (HRs) were 6.862 [95% confidence interval (CI) of 3.764-12.510] for the new-onset permanent RBBB and 3.395 (95% CI of 1.280-9.005) for LBBB, compared to those with no BBB, respectively (both < 0.05). New onset permanent RBBB in patients with new onset STEMI who underwent PCI may be correlated independently with increased risk of poor long-term prognosis.
本研究的目的是评估永久性右束支传导阻滞（RBBB）和左束支传导阻滞（LBBB）对接受经皮冠状动脉介入治疗（PCI）的新发ST段抬高型心肌梗死（STEMI）患者长期预后的潜在预测价值。纳入了2012年6月至2020年9月在我院接受急诊PCI的新发STEMI患者。采用Gensini评分（GS）评估冠状动脉病变的严重程度。本研究的主要终点是主要不良心脑血管事件（MACCEs）的发生，MACCEs是心脏死亡、心肌梗死复发、心源性休克、中风、支架血栓形成或血运重建的综合指标。我们还将全因死亡率设定为次要终点。在547例患者中，29例有新发永久性LBBB，51例有新发永久性RBBB，467例无束支传导阻滞（BBB）。根据GS评估，无BBB、新发永久性LBBB或RBBB的发生与冠状动脉病变的严重程度无关。平均随访43.93个月后，52例患者发生了MACCEs。Kaplan-Meier分析显示，与新发LBBB患者相比，新发RBBB患者发生MACCEs的风险更高（χ = 5.107， = 0.021）。此外，发现新发永久性RBBB和LBBB与MACCEs风险之间存在独立相关性。与无BBB的患者相比，新发永久性RBBB的调整后风险比（HRs）为6.862 [95%置信区间（CI）为3.764 - 12.510]，LBBB为3.395（95% CI为1.280 - 9.005）（两者均 < 0.05）。接受PCI的新发STEMI患者中的新发永久性RBBB可能与长期预后不良风险增加独立相关。
