Comparison of clinical characteristics, treatments and outcomes of patients with ST-elevation acute myocardial infarction with versus without new or presumed new left bundle branch block (from NCDR ®)

Khung Keong Yeo, Shuang Li, Ezra A Amsterdam, Tracy Y. Wang, Deepak L. Bhatt, Jorge F. Saucedo, Michael C. Kontos, Matthew T. Roe, William J. French

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Guidelines recommend urgent reperfusion for patients with new left bundle branch block (LBBB), similar to patients with ST-segment elevation myocardial infarction (STEMI). However, there are limited contemporary data comparing these 2 groups of patients. Patients presenting with acute STEMI or presumed new LBBB (nLBBB) enrolled in the Acute Coronary Treatment and Intervention Outcomes Network (ACTION) RegistryGet With the Guidelines (GWTG) from January 2007 to March 2009 were evaluated for clinical characteristics, treatment patterns, and outcomes. Logistic generalized estimating equation modeling was used to examine associated risk-adjusted mortality. Of 46,006 patients with either STEMI or nLBBB, 44,405 (96.5%) had STEMI, and 1,601 (3.5%) had nLBBB. Overall, patients with nLBBB had more baseline co-morbidities compared to those with STEMI. Compared to patients with STEMI, those with nLBBB were less likely to receive acute reperfusion (93.9% vs 48.3% p <0.0001) and were less likely to have door-to-balloon times ≤90 minutes (76.8% vs 34.5%, p <0.0001). Mortality rates were higher for patients with nLBBB compared to those with STEMI (13.3% vs 5.6%, p <0.0001). After multivariate adjustment, nLBBB was not associated with an increased risk for in-hospital mortality (odds ratio 0.91, 95% confidence interval 0.75 to 1.12, p = 0.38). In conclusion, patients with nLBBB were clinically different from those with STEMI, with significantly more co-morbidities, and were less likely to receive emergent reperfusion therapy. Despite these differences, adjusted mortality rates were similar between patients with nLBBB and those with STEMI.

Original languageEnglish (US)
Pages (from-to)497-501
Number of pages5
JournalAmerican Journal of Cardiology
Volume109
Issue number4
DOIs
StatePublished - Feb 15 2012

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Bundle-Branch Block
Reperfusion
Mortality
ST Elevation Myocardial Infarction
Guidelines
Morbidity
Hospital Mortality
Odds Ratio
Confidence Intervals

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Comparison of clinical characteristics, treatments and outcomes of patients with ST-elevation acute myocardial infarction with versus without new or presumed new left bundle branch block (from NCDR ®). / Yeo, Khung Keong; Li, Shuang; Amsterdam, Ezra A; Wang, Tracy Y.; Bhatt, Deepak L.; Saucedo, Jorge F.; Kontos, Michael C.; Roe, Matthew T.; French, William J.

In: American Journal of Cardiology, Vol. 109, No. 4, 15.02.2012, p. 497-501.

Research output: Contribution to journalArticle

Yeo, Khung Keong ; Li, Shuang ; Amsterdam, Ezra A ; Wang, Tracy Y. ; Bhatt, Deepak L. ; Saucedo, Jorge F. ; Kontos, Michael C. ; Roe, Matthew T. ; French, William J. / Comparison of clinical characteristics, treatments and outcomes of patients with ST-elevation acute myocardial infarction with versus without new or presumed new left bundle branch block (from NCDR ®). In: American Journal of Cardiology. 2012 ; Vol. 109, No. 4. pp. 497-501.
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abstract = "Guidelines recommend urgent reperfusion for patients with new left bundle branch block (LBBB), similar to patients with ST-segment elevation myocardial infarction (STEMI). However, there are limited contemporary data comparing these 2 groups of patients. Patients presenting with acute STEMI or presumed new LBBB (nLBBB) enrolled in the Acute Coronary Treatment and Intervention Outcomes Network (ACTION) RegistryGet With the Guidelines (GWTG) from January 2007 to March 2009 were evaluated for clinical characteristics, treatment patterns, and outcomes. Logistic generalized estimating equation modeling was used to examine associated risk-adjusted mortality. Of 46,006 patients with either STEMI or nLBBB, 44,405 (96.5{\%}) had STEMI, and 1,601 (3.5{\%}) had nLBBB. Overall, patients with nLBBB had more baseline co-morbidities compared to those with STEMI. Compared to patients with STEMI, those with nLBBB were less likely to receive acute reperfusion (93.9{\%} vs 48.3{\%} p <0.0001) and were less likely to have door-to-balloon times ≤90 minutes (76.8{\%} vs 34.5{\%}, p <0.0001). Mortality rates were higher for patients with nLBBB compared to those with STEMI (13.3{\%} vs 5.6{\%}, p <0.0001). After multivariate adjustment, nLBBB was not associated with an increased risk for in-hospital mortality (odds ratio 0.91, 95{\%} confidence interval 0.75 to 1.12, p = 0.38). In conclusion, patients with nLBBB were clinically different from those with STEMI, with significantly more co-morbidities, and were less likely to receive emergent reperfusion therapy. Despite these differences, adjusted mortality rates were similar between patients with nLBBB and those with STEMI.",
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