Right bundle branch block in patients with suspected myocardial infarction
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Right bundle branch block in patients with suspected myocardial infarction. / Neumann, Johannes Tobias; Sörensen, Nils Arne; Rübsamen, Nicole; Ojeda, Francisco; Schäfer, Sarina; Keller, Till; Blankenberg, Stefan; Clemmensen, Peter; Westermann, Dirk.
In: EUR HEART J-ACUTE CA, Vol. 8, No. 2, 03.2019, p. 161-166.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Right bundle branch block in patients with suspected myocardial infarction
AU - Neumann, Johannes Tobias
AU - Sörensen, Nils Arne
AU - Rübsamen, Nicole
AU - Ojeda, Francisco
AU - Schäfer, Sarina
AU - Keller, Till
AU - Blankenberg, Stefan
AU - Clemmensen, Peter
AU - Westermann, Dirk
PY - 2019/3
Y1 - 2019/3
N2 - AIMS:: The new European Society of Cardiology guideline for ST-segment elevation myocardial infarction recommends that left and right bundle branch block should be considered equal for recommending urgent angiography in patients with suspected myocardial infarction. We aimed to evaluate this novel recommendation in two prospective studies of patients with suspected myocardial infarction.METHODS AND RESULTS:: We included 4067 patients presenting to the emergency department with suspected myocardial infarction. All patients had an ECG recorded immediately upon admission. Patients were classified as having right bundle branch block (RBBB), left bundle branch block (LBBB), bifascicular block (BFB) or no bundle branch block. All patients were followed for up to two years to assess mortality. In the overall population 125 (3.1%) patients had RBBB, 281 (6.9%) LBBB and 60 (1.5%) BFB. The final diagnosis of myocardial infarction was adjudicated in 20.8% (RBBB), 28.5% (LBBB), 23.3% (BFB) and 21.6% (no complete block) of patients. The mortality rate after one year was 10.7% (RBBB), 7% (LBBB), 17.5% (BFB) and 3.2% (no complete block). The adjusted hazard ratios were 1.29 (95% confidence interval (CI) 0.71-2.34; P=0.40) for RBBB, 1.71 (95% CI 1.17-2.50; P=0.006) for LBBB and 2.27 (95% CI 1.28-4.05; P=0.005) for BFB.CONCLUSION:: Our results support the new European Society of Cardiology ST-segment elevation myocardial infarction guideline describing RBBB as a high risk for mortality in patients with suspected myocardial infarction. However, the data challenge the concept of RBBB as a trigger of acute angiography because the likelihood of myocardial infarction in a chest pain unit setting is equally frequent in patients without bundle branch block.
AB - AIMS:: The new European Society of Cardiology guideline for ST-segment elevation myocardial infarction recommends that left and right bundle branch block should be considered equal for recommending urgent angiography in patients with suspected myocardial infarction. We aimed to evaluate this novel recommendation in two prospective studies of patients with suspected myocardial infarction.METHODS AND RESULTS:: We included 4067 patients presenting to the emergency department with suspected myocardial infarction. All patients had an ECG recorded immediately upon admission. Patients were classified as having right bundle branch block (RBBB), left bundle branch block (LBBB), bifascicular block (BFB) or no bundle branch block. All patients were followed for up to two years to assess mortality. In the overall population 125 (3.1%) patients had RBBB, 281 (6.9%) LBBB and 60 (1.5%) BFB. The final diagnosis of myocardial infarction was adjudicated in 20.8% (RBBB), 28.5% (LBBB), 23.3% (BFB) and 21.6% (no complete block) of patients. The mortality rate after one year was 10.7% (RBBB), 7% (LBBB), 17.5% (BFB) and 3.2% (no complete block). The adjusted hazard ratios were 1.29 (95% confidence interval (CI) 0.71-2.34; P=0.40) for RBBB, 1.71 (95% CI 1.17-2.50; P=0.006) for LBBB and 2.27 (95% CI 1.28-4.05; P=0.005) for BFB.CONCLUSION:: Our results support the new European Society of Cardiology ST-segment elevation myocardial infarction guideline describing RBBB as a high risk for mortality in patients with suspected myocardial infarction. However, the data challenge the concept of RBBB as a trigger of acute angiography because the likelihood of myocardial infarction in a chest pain unit setting is equally frequent in patients without bundle branch block.
KW - Aged
KW - Bundle-Branch Block/diagnosis
KW - Cause of Death/trends
KW - Coronary Angiography
KW - Electrocardiography
KW - Female
KW - Follow-Up Studies
KW - Germany/epidemiology
KW - Humans
KW - Incidence
KW - Male
KW - Middle Aged
KW - Prognosis
KW - Prospective Studies
KW - ST Elevation Myocardial Infarction/complications
KW - Survival Rate/trends
U2 - 10.1177/2048872618809700
DO - 10.1177/2048872618809700
M3 - SCORING: Journal article
C2 - 30362813
VL - 8
SP - 161
EP - 166
JO - EUR HEART J-ACUTE CA
JF - EUR HEART J-ACUTE CA
SN - 2048-8726
IS - 2
ER -
