BACKGROUND: Immediate revascularization is beneficial in patients with presumed new-onset bundle branch block myocardial infarction (BBBMI). In the prehospital setting, it is a challenge to diagnose new-onset BBBMI and triage accordingly. METHODS: ECG, final diagnosis, and mortality were assessed in a prehospital cohort of 4905 consecutive patients with suspected acute myocardial infarction (AMI). Bundle branch block (BBB) was defined as QRS duration ≥120 ms caused by delayed intraventricular conduction. Mortality and angiography data were obtained from the Central Office of Civil Registration and the Western Denmark Heart Registry. Definite diagnosis of AMI and the onset of BBB were determined by expert consensus. Patients were divided into four groups: with or without AMI and with or without BBB. Mortality was evaluated by Kaplan-Meier plots and compared using log-rank statistics. RESULTS: AMI was diagnosed in 954 patients, of whom 118 had BBB. In 3951 patients without AMI, 436 had BBB. Patients with BBBMI were less often revascularized than patients with AMI without BBB (24 vs. 54%, p<0.001). BBBMI was categorized as new onset in 43 patients of whom two were triaged for acute angioplasty. One-year mortality was 47.2, 17.5, 20.8, and 8.6% (log-rank <0.001) in patients with BBBMI, patients with AMI without BBB, patients with BBB without AMI, and patients without AMI or BBB, respectively. CONCLUSIONS: Patients with BBBMI have a high mortality. Less than 25% undergo revascularization and only very few patients with new-onset BBBMI are transferred for urgent revascularization. Focus on improving triage and prehospital identification of high-risk patients with BBB and chest pain could improve outcome.
BACKGROUND: Immediate revascularization is beneficial in patients with presumed new-onset bundle branch block myocardial infarction (BBBMI). In the prehospital setting, it is a challenge to diagnose new-onset BBBMI and triage accordingly. METHODS: ECG, final diagnosis, and mortality were assessed in a prehospital cohort of 4905 consecutive patients with suspected acute myocardial infarction (AMI). Bundle branch block (BBB) was defined as QRS duration ≥120 ms caused by delayed intraventricular conduction. Mortality and angiography data were obtained from the Central Office of Civil Registration and the Western Denmark Heart Registry. Definite diagnosis of AMI and the onset of BBB were determined by expert consensus. Patients were divided into four groups: with or without AMI and with or without BBB. Mortality was evaluated by Kaplan-Meier plots and compared using log-rank statistics. RESULTS: AMI was diagnosed in 954 patients, of whom 118 had BBB. In 3951 patients without AMI, 436 had BBB. Patients with BBBMI were less often revascularized than patients with AMI without BBB (24 vs. 54%, p<0.001). BBBMI was categorized as new onset in 43 patients of whom two were triaged for acute angioplasty. One-year mortality was 47.2, 17.5, 20.8, and 8.6% (log-rank <0.001) in patients with BBBMI, patients with AMI without BBB, patients with BBB without AMI, and patients without AMI or BBB, respectively. CONCLUSIONS:Patients with BBBMI have a high mortality. Less than 25% undergo revascularization and only very few patients with new-onset BBBMI are transferred for urgent revascularization. Focus on improving triage and prehospital identification of high-risk patients with BBB and chest pain could improve outcome.
Authors: Frederick G Kushner; Mary Hand; Sidney C Smith; Spencer B King; Jeffrey L Anderson; Elliott M Antman; Steven R Bailey; Eric R Bates; James C Blankenship; Donald E Casey; Lee A Green; Judith S Hochman; Alice K Jacobs; Harlan M Krumholz; Douglass A Morrison; Joseph P Ornato; David L Pearle; Eric D Peterson; Michael A Sloan; Patrick L Whitlow; David O Williams Journal: J Am Coll Cardiol Date: 2009-12-01 Impact factor: 24.094
Authors: Sonia Jain; Henry T Ting; Malcolm Bell; Christine M Bjerke; Ryan J Lennon; Bernard J Gersh; Charanjit S Rihal; Abhiram Prasad Journal: Am J Cardiol Date: 2011-02-04 Impact factor: 2.778
Authors: Cheuk-Kit Wong; Ralph A H Stewart; Wanzhen Gao; John K French; Christopher Raffel; Harvey D White Journal: Eur Heart J Date: 2005-11-03 Impact factor: 29.983
Authors: E B Sgarbossa; S L Pinski; A Barbagelata; D A Underwood; K B Gates; E J Topol; R M Califf; G S Wagner Journal: N Engl J Med Date: 1996-02-22 Impact factor: 91.245
Authors: M B Faslur Rahuman; Jayanthimala B Jayawardena; George R Francis; Niraj Mahboob; Wasantha Kumara A H T; Aruna Wijesinghe; Rashan Haniffa; Ranithrie Ariyapperuma; Abbyramy Paramanayakam; Pubudu A De Silva Journal: Indian Heart J Date: 2017-03-06