Long-term outcomes of left bundle branch block in high-risk survivors of acute myocardial infarction: the VALIANT experience.
BACKGROUND
In survivors of myocardial infarction (MI), new left bundle branch block (LBBB) is associated with adverse outcomes, but its impact is not well described in post-MI patients with left ventricular (LV) systolic dysfunction and/or heart failure (HF).


OBJECTIVE
The aim of this study was to determine if new LBBB is an independent predictor of long-term fatal and nonfatal outcomes in high-risk survivors of MI by reviewing data from the VALsartan In Acute myocardial iNfarcTion (VALIANT) trial.


METHODS
In VALIANT, 14,703 patients with LV systolic dysfunction and/or HF were randomized to valsartan, captopril, or both a mean of 5 days after MI. Baseline ECG data were available from 14,259 patients. We assessed the predictive value of new LBBB for death and major cardiovascular outcomes after 3 years, adjusting for multiple baseline covariates including LV ejection fraction.


RESULTS
At follow-up, patients with new LBBB (608 [4.2%]) compared with patients without new LBBB had more comorbidities and increased adjusted risk of death (hazard ratio [HR] 1.3, 95% confidence interval [CI] 1.2-1.6), cardiovascular death (HR 1.4, 95% CI 1.2-1.7), HF (HR 1.3, 95% CI 1.1-1.6), MI (HR 1.5, 95% CI 1.2-1.9), and the composite of death, HF, or MI (HR 1.4, 95% CI 1.2-1.6).


CONCLUSIONS
In post-MI survivors with LV systolic dysfunction and/or HF, new LBBB was an independent predictor of all major adverse cardiovascular outcomes during long-term follow-up. This readily available ECG marker should be considered a major risk factor for long-term cardiovascular complications in high-risk patients after MI.
Stephenson
Kent
K
Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Skali
Hicham
H
McMurray
John J V
JJ
Velazquez
Eric J
EJ
Aylward
Philip G
PG
Kober
Lars
L
Van de Werf
Frans
F
White
Harvey D
HD
Pieper
Karen S
KS
Califf
Robert M
RM
Solomon
Scott D
SD
Pfeffer
Marc A
MA
D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002037:Bundle-Branch Block / Q000503:physiopathology* / Q000517:prevention & control*; D002216:Captopril / Q000627:therapeutic use*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000503:physiopathology; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012107:Research Design; D012307:Risk Factors; D013318:Stroke Volume / Q000187:drug effects; D016019:Survival Analysis; D017741:Survivors; D013777:Tetrazoles / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome; D014633:Valine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000068756:Valsartan; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000517:prevention & control
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D013777:Tetrazoles; D000068756:Valsartan; D002216:Captopril; D014633:Valine