On the other hand, the first reports on this subject from the mechanical reperfusion era persistently revealed a significantly higher short-term mortality in STEMI patients with acute RBBB or complete LBBB. Later, in the thrombolytic era, patients with ST elevation AMI (STEMI) complicated by RBBB or complete LBBB still maintained a short-term prognosis significantly worse than the individuals without acute bundle branch block. Prior to the introduction of coronary reperfusion therapies (initially the fibrinolytic treatment, and later, the mechanical reperfusion), the patients showing major IVB – that is, incomplete or complete right bundle branch block (RBBB), non-brady dependent complete left bundle branch block (LBBB) pattern, left posterior hemiblock (LPH), advanced (QRS duration > 105 msec) left anterior hemiblock (LAH), and left IVB with normal axis, non-LBBB pattern but a QRS duration of 120 msec or longer – acquired through the acute phase of myocardial infarction, frequently had a poor or very poor prognosis, especially in patients presenting with RBBB or complete LBBB. Occurrence of an intraventricular block (IVB) in patients with acute myocardial infarction (AMI) is a relatively frequent event. Intraventricular conduction defect, acute myocardial infarction, right bundle branch block, left bundle branch block, left anterior hemiblock, primary coronary angioplasty, prognosis. Emergent CA significantly improved the global prognosis of acquired major IVCD but did not significantly modify the ominous prognosis of pts with STEMI complicated by LBBB or sustained RBBB, either isolated or associated with LAH to improve the poor prognosis in these cases, primary CA should be performed within the first 2 hours of STEMI evolution.
2) Pts with new RBBB vs controls: ejection fraction 0.1) 95% mortality in pts with acquired IVCD is due to major IVCD cases (mostly pts with RBBB or LBBB).Ĭonclusions: In the era of STEMI mechanical reperfusion, the presence of preexistent IVCD has no prognostic influence.
Results: 1) Prevalences (group A): preexistent IVCD – 14.5% acquired IVCD – 27.6% (transient in 52% pts, sustained in 48%) and, specifically, isolated LAH – 15.0% (advanced LAH – 1.8%), isolated LPH – 1.3%, isolated RBBB – 3.3%, RBBB+LAH – 3.3%, RBBB+LPH – 0.2%, aspecific left IVCD – 2.3%. Some data from the present study were compared with the results of two other studies from our Group performed in the pre-thrombolytic era: a) group B – 474 pts with acute myocardial infarction (AMI), consecutively admitted in 1980-1982 (mean age of 62 and in-hospital mortality of 22%) b) group C – 764 AMI pts consecutively admitted up to 3 hours of AMI evolution in 1982-1989 (mean age of 59 and 30-day mortality of 8% in arrhythmia-free pts). Pts with new RBBB (n=40) were matched with control IVCD-free pts (n=40) for gender, age, clinical and angiographic STEMI characteristics, and comorbidities. All 12-lead ECG tracings recorded since admission to discharge/decease were reviewed and screened for the presence of LAH, advanced LAH, LPH, RBBB (isolated or associated with left IVCD), LBBB, aspecific left IVCD and aspecific bilateral IVCD the clinical profile and in-hospital evolution of IVCD pts were analyzed. Methods: Retrospective observational study of 605 STEMI pts consecutively admitted between January 1st, 2008 and June 30, 2012, with a mean admission time of 174 min, and referred to emergent coronary angiography with the intention to perform primary (effective in 92% pts, 308☓43 min after STEMI clinical start) or rescue (effective in 4% pts) CA – group A. The objective of this study is to evaluate, in an era characterized by the prominent use of emergent mechanical coronary reperfusion in STEMI, what is the impact of emergent coronary angioplasty (CA) on the prognosis of pts with STEMI complicated by IVCD.
Introduction and objective: In the pre-thrombolytic era, patients (pts) with a major intraventricular conduction defect (IVCD) – right bundle branch block (RBBB), left bundle branch block (LBBB), left posterior hemiblock (LPH), advanced (QRS > 105 msec) left anterior hemiblock (LAH) or left IVCD with normal axis and QRS > 115 msec – acquired during ST-segment elevation myocardial infarction (STEMI) very frequently had a poor in-hospital prognosis.
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