title: Prognostic implications of bundle branch block in patients undergoing primary coronary angioplasty in the stent era.
abstract: The presence of bundle branch block (BBB) in patients with ST-segment elevation myocardial infarction has been associated with a poor outcome. However, the implications of BBB in patients undergoing primary angioplasty in the stent era are poorly established. Furthermore, the prognostic implications of BBB type (right vs left and previous vs transient or persistent) remain unknown. We analyzed the data from 913 consecutive patients with ST-segment elevation myocardial infarction treated with primary angioplasty. All clinical, electrocardiographic, and angiographic data were prospectively collected. The median follow-up period was 19 months. The primary end point was the combined outcome of death and reinfarction. BBB was documented in 140 patients (15%). Right BBB (RBBB) was present in 119 patients (13%) and was previous in 27 (23%), persistent in 45 (38%), and transient in 47 (39%). Left BBB (LBBB) was present in 21 patients (2%) and was previous in 8 (38%), persistent in 9 (43%), and transient in 4 (19%). Patients with BBB were older, and more frequently had diabetes, anterior infarctions, a greater Killip class, a lower left ventricular ejection fraction, and greater mortality (all p <0.005) than patients without BBB. The short- and long-term primary outcome occurred more frequently in patients with persistent RBBB/LBBB than in those with previous or transient RBBB/LBBB. On multivariate analysis, persistent RBBB/LBBB emerged as an independent predictor of death and reinfarction. In conclusion, in patients undergoing primary angioplasty in the stent era, BBB is associated with poor short- and long-term prognosis. This risk appears to be particularly high among patients with persistent BBB.
authors.affiliation: Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain. dvivas@secardiologia.es
authors.forename: David
authors.initials: D
authors.lastname: Vivas
authors.forename: María Jose
authors.initials: MJ
authors.lastname: Pérez-Vizcayno
authors.forename: Rosana
authors.initials: R
authors.lastname: Hernández-Antolín
authors.forename: Antonio
authors.initials: A
authors.lastname: Fernández-Ortiz
authors.forename: Camino
authors.initials: C
authors.lastname: Bañuelos
authors.forename: Javier
authors.initials: J
authors.lastname: Escaned
authors.forename: Pilar
authors.initials: P
authors.lastname: Jiménez-Quevedo
authors.forename: Jose Alberto
authors.initials: JA
authors.lastname: De Agustín
authors.forename: Ivan
authors.initials: I
authors.lastname: Núñez-Gil
authors.forename: Juan Jose
authors.initials: JJ
authors.lastname: González-Ferrer
authors.forename: Carlos
authors.initials: C
authors.lastname: Macaya
authors.forename: Fernando
authors.initials: F
authors.lastname: Alfonso
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D002037:Bundle-Branch Block / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D015607:Stents; D015996:Survival Rate / Q000639:trends; D013997:Time Factors