Newby K H, Pisanó E, Krucoff M W, Green C, Natale A
Duke University/VA Medical Center, Durham, NC, USA.
Circulation. 1996 Nov 15;94(10):2424-8. doi: 10.1161/01.cir.94.10.2424.
Whether thrombolytic therapy alters the incidence and clinical outcome of bundle-branch block is unclear.
We examined the occurrence of new-onset bundle-branch block, both transient and persistent, in 681 patients with acute myocardial infarction enrolled in the Thrombolysis and Angioplasty in Myocardial Infarction 9 and Global Utilization of Streptokinase and t-PA for Occluded Arteries 1 protocols. Each patient underwent continuous 12-lead ECG monitoring for 36 to 72 hours with the Mortara ST monitoring system. Bundle-branch block was characterized as right, left, alternating, transient, or persistent. The overall incidence of bundle-branch block was 23.6% (n = 161), with transient block in 18.4% (n = 125) and persistent block in 5.3% (n = 36). Right bundle-branch block was found in 13% (n = 89) of the population; left bundle-branch block was found in 7% (n = 48). Alternating bundle-branch block was seen in 3.5% (n = 24) of patients. Left anterior descending artery infarcts accounted for most bundles (54%, n = 79). Patients with bundle-branch block had lower ejection fractions, higher peak creatine phosphokinase levels (P < .0001), and more diseased vessels (P < .019). Mortality rates in patients with and without bundle-branch block were 8.7% and 3.5%, respectively (P < .007). A higher mortality rate was observed in the presence of persistent (19.4%) versus transient (5.6%) or no (3.5%) bundle-branch block (P < .001).
Thrombolytic therapy reduces the overall mortality rate associated with persistent bundle-branch block. However, persistent bundle-branch block remains predictive of a higher mortality rate than either transient or no bundle-branch block. Continuous 12-lead ECG monitoring provides an accurate characterization of the incidence and type of conduction disturbances after acute myocardial infarction.
溶栓治疗是否会改变束支传导阻滞的发生率及临床结局尚不清楚。
我们在心肌梗死溶栓与血管成形术9（Thrombolysis and Angioplasty in Myocardial Infarction 9，TIMI 9）试验及链激酶和组织型纤溶酶原激活剂用于闭塞动脉的全球应用1（Global Utilization of Streptokinase and t-PA for Occluded Arteries 1，GUSTO-1）试验中，对681例急性心肌梗死患者新发束支传导阻滞（包括短暂性和持续性）的发生情况进行了研究。每位患者均使用莫塔拉ST监测系统进行连续36至72小时的12导联心电图监测。束支传导阻滞分为右束支、左束支、交替性、短暂性或持续性。束支传导阻滞的总体发生率为23.6%（n = 161），其中短暂性阻滞占18.4%（n = 125），持续性阻滞占5.3%（n = 36）。人群中右束支传导阻滞的发生率为13%（n = 89）；左束支传导阻滞的发生率为7%（n = 48）。3.5%（n = 24）的患者出现交替性束支传导阻滞。左前降支梗死导致的束支传导阻滞最为常见（54%，n = 79）。发生束支传导阻滞的患者射血分数较低，肌酸磷酸激酶峰值水平较高（P <.0001），病变血管较多（P <.019）。有束支传导阻滞和无束支传导阻滞患者的死亡率分别为8.7%和3.5%（P <.007）。持续性束支传导阻滞（19.4%）患者的死亡率高于短暂性束支传导阻滞（5.6%）或无束支传导阻滞（3.5%）患者（P <.001）。
溶栓治疗可降低与持续性束支传导阻滞相关的总体死亡率。然而，持续性束支传导阻滞仍然预示着比短暂性或无束支传导阻滞更高的死亡率。连续12导联心电图监测可准确描述急性心肌梗死后传导障碍的发生率及类型。
