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Clinical Characteristics, Management, and Outcomes of Acute Coronary Syndrome in Patients With Right Bundle Branch Block on Presentation.
- Source :
-
American Journal of Cardiology . 3/1/2016, Vol. 117 Issue 5, p754-759. 6p. - Publication Year :
- 2016
-
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]
- Subjects :
- *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
Subjects
Details
- Language :
- English
- ISSN :
- 00029149
- Volume :
- 117
- Issue :
- 5
- Database :
- Academic Search Index
- Journal :
- American Journal of Cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 116130032
- Full Text :
- https://doi.org/10.1016/j.amjcard.2015.12.005