TY - JOUR
T1 - Right and left bundle branch block as predictors of long-term mortality following myocardial infarction
AU - Lewinter, Christian
AU - Torp-Pedersen, Christian
AU - Cleland, John G F
AU - Køber, Lars
PY - 2011/12
Y1 - 2011/12
N2 - Aims Patients with acute myocardial infarction (MI) with bundle branch block (BBB) have a poor prognosis, but distinction between left (L)-and right (R)-sided BBB is seldom made in epidemiological studies. We studied long-term mortality associated with RBBB and LBBB in the TRAndolapril Cardiac Evaluation (TRACE) study. Methods and resultsTRACE screened consecutive patients presenting with an MI and recorded clinical, electro-and echo-cardiographic variables. Subsequently, deaths were recorded during a minimum follow-up of 15 years. In total, 6676 consecutive patients with MI were hospitalized at 27 centres in Denmark. Of these, 533 (8) had BBB, of whom 260 (4) had RBBB and 273 (4) had LBBB. Overall, 5196 (78) patients died, 256 (94) with LBBB and 235 (90) with RBBB compared with 4705 (77) of those without BBB (P < 0.001). In multivariable analyses, hazard ratios (HRs) of RBBB and LBBB were 1.23 [95 confidence interval (CI), 1.071.42] and 1.05 (95 CI, 0.911.20), respectively. There was interaction between each type of BBB and left ventricular (LV) systolic function (P 0.02). Right BBB was associated with a worse prognosis in patients with reduced LV systolic function [HR 1.31 with wall motion index (WMI) ≤ 1.5 (95 CI, 1.111.55] while LBBB had a poor prognosis in patients with preserved LV systolic (HR if WMI > 1.5, 1.70; 95 CI, 1.122.57). ConclusionsRight BBB was a predictor of increased mortality in patients with reduced LV systolic function, whereas LBBB was a marker of increased mortality in patients with preserved LV systolic function.
AB - Aims Patients with acute myocardial infarction (MI) with bundle branch block (BBB) have a poor prognosis, but distinction between left (L)-and right (R)-sided BBB is seldom made in epidemiological studies. We studied long-term mortality associated with RBBB and LBBB in the TRAndolapril Cardiac Evaluation (TRACE) study. Methods and resultsTRACE screened consecutive patients presenting with an MI and recorded clinical, electro-and echo-cardiographic variables. Subsequently, deaths were recorded during a minimum follow-up of 15 years. In total, 6676 consecutive patients with MI were hospitalized at 27 centres in Denmark. Of these, 533 (8) had BBB, of whom 260 (4) had RBBB and 273 (4) had LBBB. Overall, 5196 (78) patients died, 256 (94) with LBBB and 235 (90) with RBBB compared with 4705 (77) of those without BBB (P < 0.001). In multivariable analyses, hazard ratios (HRs) of RBBB and LBBB were 1.23 [95 confidence interval (CI), 1.071.42] and 1.05 (95 CI, 0.911.20), respectively. There was interaction between each type of BBB and left ventricular (LV) systolic function (P 0.02). Right BBB was associated with a worse prognosis in patients with reduced LV systolic function [HR 1.31 with wall motion index (WMI) ≤ 1.5 (95 CI, 1.111.55] while LBBB had a poor prognosis in patients with preserved LV systolic (HR if WMI > 1.5, 1.70; 95 CI, 1.122.57). ConclusionsRight BBB was a predictor of increased mortality in patients with reduced LV systolic function, whereas LBBB was a marker of increased mortality in patients with preserved LV systolic function.
U2 - 10.1093/eurjhf/hfr130
DO - 10.1093/eurjhf/hfr130
M3 - Journal article
SN - 1567-4215
VL - 13
SP - 1349
EP - 1354
JO - European Journal of Heart Failure, Supplement
JF - European Journal of Heart Failure, Supplement
IS - 12
ER -