Liu Hong, Yuan Yu, Dong Yu, Yang Ying, Yang Xitong, Sun Biao, Ma Lilan, Li Tao, Wu Xin-Hua
Department of Cardiology, The first Affiliated Hospital of Dali University, Yunnan, China.
Yunnan Trans-plateau Cardiovascular Disease of Prevention and Treatment Research Center, Yunnan, China.
BMC Cardiovasc Disord. 2025 May 29;25(1):414. doi: 10.1186/s12872-025-04872-9.
This study sought to investigate clinical characteristics of acute anterior ST-segment elevation myocardial infarction (STEMI) patients complicated by new complete right bundle branch block (CRBBB) and evaluate the occurrence of microcirculatory dysfunction post-percutaneous coronary intervention (PCI).
Retrospective analysis was conducted on 261 patients with acute anterior STEMI, differentiating 40 with concurrent new CRBBB (CRBBB group) from 221 without (no-CRBBB group). Data on demographics and hospitalization were collected, and clinical features and prognoses were compared. Post-PCI microcirculatory function was further characterized using coronary angiography-derived index of microcirculatory resistance (caIMR), thrombolysis in myocardial infarction (TIMI) grade flow, corrected TIMI flow frame count (CTFC) of the infarct-related artery, and ST segment regression in electrocardiograph (STR).
Age, Killip class, GLUC, TG, HDL, BUN, GFR, AST, ALT, WBC, TNI at admission significantly differed between groups (P < 0.05). Incidences of in-hospital major adverse cardiovascular events and LVEF showed significant disparities (P < 0.05). The CRBBB group exhibited higher CaIMR, lower TIMI flow, and STR (P < 0.05). Multivariate analysis indicated TIMI ≤ grade 2 (OR = 6.833, 95% CI: 1.009 ~ 46.287, P = 0.049), STR ≥ 50% (OR = 0.176, 95% CI: 0.051 ~ 0.606, P = 0.006), CTFC (OR = 1.079, 95% CI: 1.009 ~ 1.155, P = 0.027), and caIMR (OR = 1.120, 95% CI: 1.059 ~ 1.185, P < 0.001) were independently linked to new onset of CRBBB. Complicated of new CRBBB was strongly associated with elevated CaIMR in anterior STEMI patients. (OR = 5.065, 95% CI:1.793-14.308, P = 0.002).
In patients with acute anterior STEMI, those with new CRBBB are at an increased likelihood of experiencing microcirculatory dysfunction.
本研究旨在探讨合并新发完全性右束支传导阻滞（CRBBB）的急性前壁ST段抬高型心肌梗死（STEMI）患者的临床特征，并评估经皮冠状动脉介入治疗（PCI）后微循环功能障碍的发生情况。
对261例急性前壁STEMI患者进行回顾性分析，将40例并发新发CRBBB的患者分为CRBBB组，221例未并发的患者分为非CRBBB组。收集人口统计学和住院数据，比较临床特征和预后。PCI术后使用冠状动脉造影衍生的微循环阻力指数（caIMR）、心肌梗死溶栓（TIMI）血流分级、梗死相关动脉的校正TIMI血流帧数（CTFC）和心电图ST段回落（STR）进一步评估微循环功能。
两组患者的年龄、Killip分级、血糖、甘油三酯、高密度脂蛋白、血尿素氮、肾小球滤过率、谷草转氨酶、谷丙转氨酶、白细胞、入院时肌钙蛋白I水平差异有统计学意义（P<0.05）。住院期间主要不良心血管事件发生率和左心室射血分数差异有统计学意义（P<0.05）。CRBBB组的CaIMR较高，TIMI血流和STR较低（P<0.05）。多因素分析显示，TIMI≤2级（OR=6.833，95%CI：1.009～46.287，P=0.049）、STR≥50%（OR=0.176，95%CI：0.051～0.606，P=0.006）、CTFC（OR=1.079，95%CI：1.009～1.155，P=0.027）和caIMR（OR=1.120，95%CI：1.059～1.185，P<0.001）与新发CRBBB独立相关。急性前壁STEMI患者并发新发CRBBB与CaIMR升高密切相关（OR=5.065，95%CI：1.793～14.308，P=0.002）。
急性前壁STEMI患者中，新发CRBBB患者发生微循环功能障碍的可能性增加。
