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Am J Cardiol. 2016 Mar 1;117(5):754-9. doi: 10.1016/j.amjcard.2015.12.005. Epub 2015 Dec 12.

Clinical Characteristics, Management, and Outcomes of Acute Coronary Syndrome in Patients With Right Bundle Branch Block on Presentation.

Author information

1
Terrence Donnelly Heart Centre, Department of Medicine, St Michael's Hospital, Toronto, Canada; University of Toronto, Toronto, Canada.
2
Terrence Donnelly Heart Centre, Department of Medicine, St Michael's Hospital, Toronto, Canada; University of Toronto, Toronto, Canada; Canadian Heart Research Centre, Toronto, Canada.
3
Coronary Care Unit, Concord Hospital, Sydney, Australia.
4
Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, United Kingdom.
5
Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom.
6
Department of Cardiovascular Medicine, Department of Cardiovascular Medicine Flinders University, Adelaide, South Australia, Australia.
7
University of Toronto, Toronto, Canada; Women's College Hospital, Toronto, Canada.
8
Hospital Universitario La Paz, Madrid, Spain.
9
McGill University Health Centre, McGill University, Montreal, Canada.
10
University of Toronto, Toronto, Canada.
11
University of Toronto, Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada.
12
Terrence Donnelly Heart Centre, Department of Medicine, St Michael's Hospital, Toronto, Canada; University of Toronto, Toronto, Canada. Electronic address: yana@smh.ca.

Abstract

We examined the relations between right bundle branch block (RBBB) and clinical characteristics, management, and outcomes among a broad spectrum of patients with acute coronary syndrome (ACS). Admission electrocardiograms of patients enrolled in the Global Registry of Acute Coronary Events (GRACE) electrocardiogram substudy and the Canadian ACS Registry I were analyzed independently at a blinded core laboratory. We performed multivariable logistic regression analysis to assess the independent prognostic significance of admission RBBB on in-hospital and 6-month mortality. Of 11,830 eligible patients with ACS (mean age 65; 66% non-ST-elevation ACS), 5% had RBBB. RBBB on admission was associated with older age, male sex, more cardiovascular risk factors, worse Killip class, and higher GRACE risk score (all p <0.01). Patients with RBBB less frequently received in-hospital cardiac catheterization, coronary revascularization, or reperfusion therapy (all p <0.05). The RBBB group had higher unadjusted in-hospital (8.8% vs 3.8%, p <0.001) and 6-month mortality rates (15.1% vs 7.6%, p <0.001). After adjusting for established prognostic factors in the GRACE risk score, RBBB was a significant independent predictor of in-hospital death (odds ratio 1.45, 95% CI 1.02 to 2.07, p = 0.039), but not cumulative 6-month mortality (odds ratio 1.29, 95% CI 0.95 to 1.74, p = 0.098). There was no significant interaction between RBBB and the type of ACS for either in-hospital or 6-month mortality (both p >0.50). In conclusion, across a spectrum of ACS, RBBB was associated with preexisting cardiovascular disease, high-risk clinical features, fewer cardiac interventions, and worse unadjusted outcomes. After adjusting for components of the GRACE risk score, RBBB was a significant independent predictor of early mortality.

PMID:
26762726
DOI:
10.1016/j.amjcard.2015.12.005
[Indexed for MEDLINE]

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