1. Clinical Characteristics, Management, and Outcomes of Acute Coronary Syndrome in Patients With Right Bundle Branch Block on Presentation.
- Author
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Chan, William K, Goodman, Shaun G, Brieger, David, Fox, Keith A A, Gale, Chris P, Chew, Derek P, Udell, Jacob A, Lopez-Sendon, Jose, Huynh, Thao, Yan, Raymond T, Singh, Sheldon M, Yan, Andrew T, and ACS I and GRACE Investigators
- Subjects
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TREATMENT of acute coronary syndrome , *BUNDLE-branch block , *COMPARATIVE studies , *ELECTROCARDIOGRAPHY , *RESEARCH methodology , *MEDICAL cooperation , *PROGNOSIS , *RESEARCH , *RESEARCH funding , *RISK assessment , *SURVIVAL , *DISEASE management , *EVALUATION research , *DISEASE incidence , *ACQUISITION of data , *ACUTE coronary syndrome , *HOSPITAL mortality , *ODDS ratio , *DISEASE complications , *DIAGNOSIS - Abstract
We examined the relations between right bundle branch block (RBBB) and clinical characteristics, management, and outcomes among a broad spectrum of patients with acute coronary syndrome (ACS). Admission electrocardiograms of patients enrolled in the Global Registry of Acute Coronary Events (GRACE) electrocardiogram substudy and the Canadian ACS Registry I were analyzed independently at a blinded core laboratory. We performed multivariable logistic regression analysis to assess the independent prognostic significance of admission RBBB on in-hospital and 6-month mortality. Of 11,830 eligible patients with ACS (mean age 65; 66% non-ST-elevation ACS), 5% had RBBB. RBBB on admission was associated with older age, male sex, more cardiovascular risk factors, worse Killip class, and higher GRACE risk score (all p <0.01). Patients with RBBB less frequently received in-hospital cardiac catheterization, coronary revascularization, or reperfusion therapy (all p <0.05). The RBBB group had higher unadjusted in-hospital (8.8% vs 3.8%, p <0.001) and 6-month mortality rates (15.1% vs 7.6%, p <0.001). After adjusting for established prognostic factors in the GRACE risk score, RBBB was a significant independent predictor of in-hospital death (odds ratio 1.45, 95% CI 1.02 to 2.07, p = 0.039), but not cumulative 6-month mortality (odds ratio 1.29, 95% CI 0.95 to 1.74, p = 0.098). There was no significant interaction between RBBB and the type of ACS for either in-hospital or 6-month mortality (both p >0.50). In conclusion, across a spectrum of ACS, RBBB was associated with preexisting cardiovascular disease, high-risk clinical features, fewer cardiac interventions, and worse unadjusted outcomes. After adjusting for components of the GRACE risk score, RBBB was a significant independent predictor of early mortality. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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