New permanent bundle-branch block and long-term prognosis of patients with new onset ST-elevation myocardial infarction who underwent percutaneous coronary intervention

Abstract

Aim: The aim of the study was to evaluate the potential predictive value of permanent RBBB and LBBB for longer-term prognosis in patients with new-onset STEMI who underwent percutaneous coronary intervention (PCI).Methods: Patients with new-onset STEMI that underwent emergency PCI at our department from June 2012 to September 2020 were included in the study. Gensini score (GS) was employed to evaluate the severity of coronary lesions. The primary endpoint of the study was the occurrence of major adverse cardiac and cerebrovascular events (MACCEs), the composite of cardiac mortality, recurrence of myocardial infarction, cardiac shock, stroke, stent thrombosis, or revascularization. We also set all-cause mortality as a secondary endpoint.Results: Out of the 547 patients, 29 patients had new-onset permanent LBBB, 51 patients had new-onset permanent RBBB, and 467 patients had no bundle-branch block (BBB). The occurrence of no BBB, new permanent LBBB, or RBBB was not associated with the severity of coronary artery lesions as evaluated by the GS. After follow-up at an average of 43.93 months, MACCEs occurred in 52 patients. Kaplan-Meier analysis showed that patients with new-onset RBBB were at greater risk for MACCEs compared to those with new onset LBBB (χ2 = 5.107, p = 0.021). Also, an independent correlation was found between new permanent RBBB and LBBB and MACCEs risk. The adjusted hazard ratios (HRs) were 6.862 [95% confidence interval (CI) of 3.764–12.510] for the new-onset permanent RBBB and 3.395 (95% CI of 1.280–9.005) for LBBB, compared to those with no BBB, respectively (both p < 0.05).Conclusion: New onset permanent RBBB in patients with new onset STEMI who underwent PCI may be correlated independently with increased risk of poor long-term prognosis.

The ratio of QRS/RV6-V1: a new electrocardiographic predictor of short- and long-term adverse clinical outcomes in patients with acute myocardial infarction combined with new-onset right bundle branch block

“…New-onset RBBB has been included as an early indication of revascularization since 2017 in ESC guidelines for STEMI, thereby highlighting its value in primary revascularization ( 5 ). The prognostic value of new-onset RBBB in AMI has been demonstrated ( 4 , 8 , 20 ). Previous studies even proposed that the mortality of patients with AMI combined with RBBB was higher than that combined with LBBB ( 21 ), especially atypical RBBB ( 7 , 8 ).…”

“…The previous studies demonstrated that many ECG parameters are associated with the prognosis of AMI (2). New-onset right bundle branch block (RBBB) is a well-recognized ECG marker predicting high mortality (3,4) and an indication of emergency revascularization for AMI patients (5). Owing to the independent blood supply of the right bundle branch (RBB) from the left anterior descending artery (LAD), the incidence of new-onset RBBB in AMI is higher than that of the left branch bundle block (LBBB) (6).…”

Conduction system pacing on track to replace CRT? Review of current evidence and prospects of conduction system pacing

“…Incidental finding of LBBB in the presence of scar, as shown on cardiac magnetic resonance (CMR) imaging, has worse outcomes than those who have no scar ( 6 ). Bundle branch block (BBB) is deleterious on long-term cardiovascular outcomes and has higher mortality in those individuals with myocardial infarction or abrupt BBB following a percutaneous procedure such as percutaneous coronary intervention (PCI) or transcatheter aortic valve implantation (TAVI) ( 7 ). Meta-analysis of studies shows any form of BBB to have a higher association with mortality in patients presenting with acute heart failure ( 8 ).…”