Impact of Quantitative ST-T Analysis in Patients With Suspected Myocardial Infarction Presenting With Right Bundle Branch Block.
Am J Med
; 137(8): 770-775.e1, 2024 08.
Article
em En
| MEDLINE
| ID: mdl-38670517
ABSTRACT
BACKGROUND:
While left bundle branch block (LBBB) is a well-known risk feature in patients with acute myocardial infarction, and a rapid invasive management is recommended, data supporting this strategy for patients with right bundle branch block (RBBB) is less robust.METHODS:
In total, 2139 patients with suspected ST-elevation myocardial infarction (STEMI) were triaged to acute coronary angiography based on a prehospital 12-lead electrocardiogram (ECG). Sensitivity and specificity for STEMI-ECG criteria were compared in RBBB and non-BBB patients. Adjusted hazard ratios for 1-year overall mortality were computed.RESULTS:
STEMI was adjudicated in 1832/2139 (85.6%) of all patients and in 102/117 (87.2%) of RBBB patients. ST-segment deviation followed typical ST-T patterns in most RBBB patients. Of 17 RBBB patients without significant ST changes, STEMI was adjudicated in 14 (82%). Diagnostic accuracy of STEMI criteria was comparable in RBBB and non-RBBB patients for inferior (sensitivity 51.1% vs 59.1%, P = .14; specificity 66.7% vs 52.1%, P = .33) and anterior STEMI (sensitivity 35.2% vs 36.6%, P = .80; specificity 58.3% vs 49.5%, P = .55). Diagnostic performance was lower for lateral STEMI in RBBB patients (sensitivity 14.8% vs 4.4%, P = .001; specificity 75.0% vs 98.4%, P < .001). Patients with RBBB had higher 1-year mortality compared with non-BBB patients (hazard ratio 2.3%; 95% confidence interval, 1.25-4.21.CONCLUSION:
ECG criteria used for detection of STEMI showed comparable diagnostic accuracy in RBBB and non-BBB patients. However, STEMI was frequently present in RBBB patients not fulfilling diagnostic ECG criteria. RBBB patients showed poorer outcome after 1 year. Consequently, the presence of RBBB in suspected STEMI cases signifies a high-risk feature, aligning with established guidelines.Palavras-chave
Texto completo:
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Bloqueio de Ramo
/
Angiografia Coronária
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Eletrocardiografia
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Infarto do Miocárdio com Supradesnível do Segmento ST
Limite:
Aged
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Female
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Humans
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Male
/
Middle aged
Idioma:
En
Revista:
Am J Med
Ano de publicação:
2024
Tipo de documento:
Article