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

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• 作者：William K. Chan ; MD^a ; ^b ; Shaun G. Goodman ; MD ; MSc^a ; ^b ; ^c ; David Brieger ; MBBS ; PhD^d ; Keith A.A. Fox ; MBChB^e ; Chris P. Gale ; MBBS ; PhD^f ; Derek P. Chew ; MBBS ; PhD^g ; Jacob A. Udell ; MD ; MPH^b ; ^h ; Jose Lopez-Sendon ; MDⁱ ; Thao Huynh ; MD^j ; Raymond T. Yan ; MD^b ; Sheldon M. Singh ; MD^b ; ^k ; Andrew T. Yan ; MD^a ; ^b ; ^{yana@smh.ca" class="auth_mail" title="E-mail the corresponding author} ; on behalf of the ACS I ; GRACE Investigators
• 刊名：The American Journal of Cardiology
• 出版年：2016
• 出版时间：1 March 2016
• 年：2016
• 卷：117
• 期：5
• 页码：754-759
• 全文大小：628 K

文摘

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.