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07. Syncope and Bradycardia
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32. Cardiovascular Nursing
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Prognostic impact of intraventricular conduction defects in patients with STEMI
Session:
Painel 6 - Doença Coronária 7
Speaker:
SARA ISABEL LOPES FERNANDES
Congress:
CPC 2020
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:
Sara Lopes Fernandes; Fernando Montenegro Sá; Margarida S. Cabral; Rita Ribeiro Carvalho; Luís Graça Santos; Catarina Ferreira Ruivo; Sidarth Pernencar; Joao Morais; On behalf of all the investigators of the National Registry on Acute Coronary Syndromes
Abstract
<p><strong>Introduction: </strong>Patients with a clinical suspicion of ongoing myocardial ischaemia and left bundle branch block (LBBB) should be managed in a way similar to ST-segment elevation myocardial infarction (STEMI) patients. Left and right bundle branch block (RBBB) are now considered equal for recommending urgent angiography if ischaemic symptoms are present.</p> <p><strong>Aim</strong>: To assess, in patients with STEMI, the impact on in-hospital outcomes according to the presence or absence of bundle branch block (BBB)</p> <p><strong>Methods: </strong>From a consecutive series of patients included in the National Registry of Acute Coronary Syndrome between 10/1/2010 and 9/1/2019, were selected patients with STEMI or undetermined acute myocardial infarction (MI) undergoing coronary angiography, with baseline electrocardiogram information. Three groups were defined: group 1- with LBBB, group 2 – with RBBB and group 3 - no BBB. All data about baseline characteristics, in hospital management and procedures and coronary anatomy were collected. The 3 groups were compared in an univariate way (with vs without BBB; RBBB vs LBBB). A Logistic regression analysis was done to assess the independent association of RBBB with in-hospital mortality.</p> <p><strong>Results: </strong>7805 patients were included: group 1- 461 (5.9%); group 2- 374 (4.8%); group 3- 6970 (89.3%). By definition, the diagnosis of STEMI was established more often in groups 2 and 3 (29.3% vs 99.5% vs 98.2%, p<0.001), while patients with in group 1 had more undetermined acute MI (71% vs 0.5% vs 1.8%, p<0.001). Baseline characteristics and comparisons between the groups are shown in Table 1. Group 1 presented lower left ventricular ejection fraction (42±13% vs 46±13% vs 50±12%, p<0.001) and BBB (right or left) doubled the risk of in-hospital heart failure (35% vs 35% vs 16%, p<0.001). Major complications were more frequent in group 2 namely: atrioventricular block (4.3% vs 10.5% vs 4.7%, p<0.001), cardiogenic shock (8.1% vs 14.1% vs 5.3%, p<0.001) and in-hospital mortality (5% vs 12.8% vs 3.1%, p<0.001). After multivariate analysis, RBBB remained an independent predictor of in-hospital mortality (OR 1.91, 95% CI 1.04-3.50, p=0.038). The model showed good calibration (Hosmer & Lemeshow test p=0.846) and discrimination (AUC 0.931).</p> <p><strong>Conclusion: </strong>In the current series the presence of BBB is associated with worse in-hospital outcomes. Specially RBBB doubles the risk of death in STEMI patients and is an independent predictor of in-hospital mortality.</p>
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