title: Incidence and prognostic significance of right bundle branch block in patients with acute myocardial infarction receiving thrombolytic therapy.
abstract: We assessed the incidence and prognostic significance of right bundle branch block (RBBB) in patients with acute myocardial infarction (AMI) receiving thrombolytic therapy. A prospective, one-year follow-up study involving 681 consecutive patients treated with thrombolytic agents for AMI was performed. Seventy-four patients developed RBBB (46% new-onset, 24% old and 30% indeterminate). RBBB was more common in older patients with large anterior AMI. New-onset RBBB were often transient (56%) and 84% of them resolved within 12 h after admission. Complicating events during the hospital phase, such as ventricular arrhythmias and development of heart failure, were more frequent in patients with RBBB. In-hospital and one-year mortality were higher in patients with RBBB (22.9 and 40.5% compared to 7.9 and 12.3% respectively in patients without block, both p<0.001). New-onset, non-transient RBBB were associated with the highest mortality rates (73% at one-year follow-up). By multivariate analysis, RBBB was retained as independent predictor of in-hospital and one-year mortality. We conclude that new-onset RBBB in patients receiving thrombolytic therapy for AMI is often transient. The development of RBBB has a negative and independent prognostic impact on the survival during the hospital phase and at one-year follow-up.
authors.affiliation: Department of Cardiology, Hospital del Rosell, Cartagena, Spain.
authors.forename: A M
authors.initials: AM
authors.lastname: Moreno
authors.forename: A G
authors.initials: AG
authors.lastname: Alberola
authors.forename: J G
authors.initials: JG
authors.lastname: Tomás
authors.forename: M V
authors.initials: MV
authors.lastname: Chávarri
authors.forename: F C
authors.initials: FC
authors.lastname: Soria
authors.forename: E M
authors.initials: EM
authors.lastname: Sánchez
authors.forename: J G
authors.initials: JG
authors.lastname: Sánchez
mesh_terms: D000368:Aged; D002037:Bundle-Branch Block / Q000209:etiology*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D013300:Streptokinase / Q000627:therapeutic use*; D016019:Survival Analysis; D015912:Thrombolytic Therapy
chemical_list: D005343:Fibrinolytic Agents; D013300:Streptokinase