American Heart Journal
Volume 156, Issue 2 , Pages 256-261, August 2008

Incidence and clinical impact of right bundle branch block in patients with acute myocardial infarction: ST elevation myocardial infarction versus non-ST elevation myocardial infarction

  • Thomas Kleemann, MD

      Affiliations

    • Herzzentrum Ludwigshafen, Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen, Germany
    • Corresponding Author InformationReprint requests: Thomas Kleemann, MD, Herzzentrum Ludwigshafen, Zentrum für Herzrhythmusstörungen, Bremserstraße 79, 67063 Ludwigshafen, Germany.
    • ,
  • Claus Juenger, MPH

      Affiliations

    • Herzzentrum Ludwigshafen, Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen, Germany
    • ,
  • Anselm Kai Gitt, MD

      Affiliations

    • Herzzentrum Ludwigshafen, Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen, Germany
    • ,
  • Rudolf Schiele, MD

      Affiliations

    • Herzzentrum Ludwigshafen, Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen, Germany
    • ,
  • Steffen Schneider, PhD

      Affiliations

    • Herzzentrum Ludwigshafen, Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen, Germany
    • ,
  • Jochen Senges, MD, FESC

      Affiliations

    • Herzzentrum Ludwigshafen, Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen, Germany
    • ,
  • Harald Darius, MD

      Affiliations

    • Vivantes-Klinikum Neukölln, Berlin, Germany
    • ,
  • Karlheinz Seidl, MD, FESC

      Affiliations

    • Herzzentrum Ludwigshafen, Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen, Germany
    • ,
  • for the MITRA PLUS Study Group

Received 19 November 2007; accepted 4 March 2008. published online 20 June 2008.

Background

Both left bundle branch block and right bundle branch block (RBBB) have been associated with increased inhospital and long-term mortality in patients with acute ST elevation myocardial infarction (STEMI). However, the prognostic role of RBBB in acute non-ST elevation myocardial infarction (NSTEMI) is not well known. Therefore, the aim of the study was to evaluate the incidence and clinical impact of RBBB in patients with NSTEMI compared to patients with STEMI.

Methods

From the German prospective multicenter registry “Maximal Individual Therapy of Acute Myocardial Infarction” (MITRA PLUS), 6,403 consecutive patients with NSTEMI and 20,233 patients with STEMI were analyzed. Patients with left bundle branch block were excluded. The median follow-up time for NSTEMI was 378 days and for STEMI 479 days.

Results

A total of 455 (7.1%) patients with NSTEMI and 894 (4.4%) patients with STEMI presented with RBBB on admission. In general, RBBB patients were older, more often had comorbidities, and less often received short-term inhospital treatment according to guidelines. In STEMI, RBBB patients had higher peak enzyme levels and lower left ventricular ejection fraction (LV-EF) than patients without BBB. Right bundle branch block in STEMI was associated with an increased inhospital and long-term mortality. In NSTEMI, however, peak enzyme levels and LV-EF were similar in both groups with and without RBBB. Right bundle branch block in NSTEMI was not independently associated with a worse outcome.

Conclusions

Unlike RBBB in STEMI, RBBB in NSTEMI is not an independent predictor of inhospital and long-term mortality.

To access this article, please choose from the options below

Login to an existing account or Register a new account.

  • Purchase this article for 31.50 USD (You must login/register to purchase this article)

    Online access for 24 hours. The PDF version can be downloaded as your permanent record.

  • Subscribe to this title

    Get unlimited online access to this article and all other articles in this title 24/7 for one year.

  • Claim access now

    For current subscribers with Society Membership or Account Number.

  • Visit SciVerse ScienceDirect to see if you have access via your institution.
 

 The MITRA PLUS study was supported by the Landesversicherungsanstalt, Rheinland-Pfalz, Germany; Ministry for Employment, Public Health and Social Affairs, Rheinland-Pfalz, Germany; MSD Sharp&Dohme, Haar, Germany; Bristol-Myers Squibb, München, Germany; Aventis Pharma, Bad Soden, Germany; AstraZeneca, Wedel, Germany; Pfizer, Karlsruhe, Germany; and Abbott, Ludwigshafen, Germany.

PII: S0002-8703(08)00163-4

doi:10.1016/j.ahj.2008.03.003

American Heart Journal
Volume 156, Issue 2 , Pages 256-261, August 2008

Article Tools

* Image Usage & Resolution