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01. History of Cardiology
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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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32. Cardiovascular Nursing
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The true impact in outcome of left and right bundle branch block in acute coronary syndrome
Session:
Posters 3 - Écran 10 - Isquemia/SCA
Speaker:
Silvia Aguiar
Congress:
CPC 2018
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Sílvia Aguiar Rosa; Ana Teresa Timóteo; Maria De Lurdes Ferreira; Ramiro Sá Carvalho; Dra. Inês Rodrigues; Pedro Daniel; Luís Almeida Morais; Madalena Coutinho Cruz; Rita Ilhão Moreira; António Valentim Gonçalves; Tiago Mendonça; Helena Aidos; Rui Cruz Ferreira
Abstract
<p><strong>Purpose:</strong> Evaluation of in-hospital outcome of acute coronary syndrome (ACS) patients (P) presented with left (LBBB) and right bundle branch block (RBBB), and comparison with ST elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) /unstable angina (UA) P.</p> <p> </p> <p><strong>Methods:</strong> Prospective analysis of ACS P admitted from 2005 to 2017. P were divided according to the electrocardiogram at admission: LBBB, RBBB, STEMI and NSTEMI/UA (without LBBB / RBBB). Clinical, echocardiographic and angiographic characteristics were analysed and in-hospital outcome compared between study groups.</p> <p> </p> <p><strong>Results:</strong> 5361 P were enrolled, age 63.7±13.2 years, 70.5% males. </p> <p>199 P (3.7%) presented LBBB, 242 P (4.5%) RBBB, 3151 P (58.8%) STEMI and 1769 P (33.0%) NSTEMI/UA.</p> <p>LBBB and RBBB P were older (LBBB 72.1±10.3 vs RBBB 70.3±11.3 vs STEMI 62.1±13.5 vs NSTEMI/UA 64.9±12.3 years; p<0.001), had more diabetes (LBBB 39.7%; RBBB 34.7%; STEMI 22.8%; NSTEMI/UA 27.0%; p<0.001) and chronic kidney disease (CKD) (LBBB 7.5%; RBBB 5.4%; STEMI 1.9%; NSTEMI/UA 3.1%; p<0.001).</p> <p>41.4% of LBBB P and 25.9% of RBBB P presented Killip class > I, contrasting with 14% in STEMI and NSTEMI/UA groups (p<0.001).</p> <p>32.9% of LBBB P presented left ventricular ejection fraction (LVEF) <35%, comparing with 11.2% in RBBB, 6.7% in STEMI and 6.6% in NSTEMI/UA (p<0.001).</p> <p>Cardiogenic shock was more prevalent in patients with STEMI and BBB (LBBB 6.0%; RBBB 8.7%; STEMI 6.5%; NSTEMI/UA 2.6%; p<0.001). Intra-aortic balloon pump was used in 2.5% of LBBB P followed by STEMI P (2.2%), RBBB P (1.7%) and NSTEMI/UA P (0.9%) (p=0.0032).</p> <p>LBBB (6.0%), RBBB (6.6%) and STEMI (5.4%) groups presented more ventricular arrhythmias than NSTEMI/UA (1.4%) (p<0.001).</p> <p>Mechanical ventilation was more needed in patients with LBBB (8.0%) and RBBB (9.5%), comparing with STEMI (6.3%) and NSTEMI (3.3%) (p<0.001).</p> <p>The incidence of acute kidney injury was higher in LBBB P (LBBB 8.0%; RBBB 4.6%; STEMI 3.7%; NSTEMI/UA 2.7%; p=0.001).</p> <p>Urgent percutaneous coronary intervention was performed in 24.6% of P with LBBB and in 38.8% of P with RBBB.</p> <p>There was not significant difference in prevalence of multivessel disease between groups (about 50%).</p> <p>Length of stay was longer in LBBB P (10.87±12.85 days) followed by RBBB (8.44±9.02 days) (STEMI 7.23±10.76; NSTEMI/UA 7.72±22.15 days; p<0.001)</p> <p>In-hospital mortality was higher in RBBB P (7.4%) and LBBB P (5.5%) (vs 4.3% in STEMI and 2.3% in NSTEMI/UA; p <0.001). After adjustment for remaining variates (STEMI, NSTEMI/UA, age, Killip class, LVEF, systolic blood pressure, heart rate, chronic kidney disease) P with LBBB had 25% lower risk of death comparing with RBBB P (OR 0.250; CI [0.074; 0.808]).</p> <p> </p> <p><strong>Conclusion: </strong>LBBB and RBBB were associated with worst in-hospital outcome including left ventricular dysfunction, heart failure, respiratory insufficiency and renal dysfunction. Furthermore, in-hospital mortality associated to LBBB and RBBB was even higher than in STEMI.</p>
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