title: Prevalence of acute myocardial infarction in patients with presumably new left bundle-branch block.
abstract: OBJECTIVE
  We assessed the prevalence of true acute myocardial infarction and the need for emergent revascularization among patients with new or presumably new left bundle branch block (nLBBB) for whom the primary percutaneous coronary intervention protocol was activated.
  
  
  RESULTS
  Among 802 patients, 69 (8.6%) had nLBBB. The chief presenting symptom was chest pain or cardiac arrest in 36 patients (52.2%) and shortness of breath in 15 (21.7%). Less than 30% of the patients had elevated cardiac troponin-I, and less than 10% had elevated creatine kinase-MB. Only 11.6% of the patients underwent emergent revascularization; the rate was higher for patients who presented with chest pain or cardiac arrest or shortness of breath than for patients who presented with other symptoms.
  
  
  CONCLUSIONS
  Acute myocardial infarction and the need for emergent revascularization are relatively uncommon among patients who present with nLBBB, especially when symptoms are atypical. Current guidelines for primary percutaneous coronary intervention protocol activation for nLBBB should be reconsidered.
authors.affiliation: Division of Cardiology, University of Texas Medical Branch, Galveston, TX.
authors.forename: Nilay
authors.initials: N
authors.lastname: Mehta
authors.affiliation: Section of Cardiology, Baylor College of Medicine, Houston, TX.
authors.forename: Henry D
authors.initials: HD
authors.lastname: Huang
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, TX.
authors.forename: Salman
authors.initials: S
authors.lastname: Bandeali
authors.affiliation: Section of Cardiology, Baylor College of Medicine, Houston, TX; Department of Cardiology, the Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, TX.
authors.forename: James M
authors.initials: JM
authors.lastname: Wilson
authors.affiliation: Section of Cardiology, Baylor College of Medicine, Houston, TX; Department of Cardiology, the Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, TX. Electronic address: ybirnbau@bcm.edu.
authors.forename: Yochai
authors.initials: Y
authors.lastname: Birnbaum
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002037:Bundle-Branch Block / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D052279:Creatine Kinase, MB Form / Q000097:blood; D004562:Electrocardiography; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D019210:Troponin I / Q000097:blood
chemical_list: D019210:Troponin I; D052279:Creatine Kinase, MB Form