16 Nov LBBB Signals High Risk in Heart Attack Patients

MedicalResearch.com Interview with:

Dr. Dragana Radovanovic

Dragana Radovanovic, MD
Head of AMIS Plus Data Center
Epidemiology, Biostatistics and Prevention Institute (EBPI)
University of Zurich
Zurich Switzerland

MedicalResearch.com: What is the background for this study?

Response: Although patients presenting with new or presumed new left bundle branch block (LBBB) represent a minority of the patients admitted with suspected acute myocardial infarction (AMI), they remain a challenging and unresolved diagnostic and therapeutic dilemma in routine clinical practice. Large trials such as PLATO or SHOCK have evaluated AMI therapy and considered ST-elevation MI (STEMI) and new LBBB as a single diagnostic group. Currently, European and American guidelines differ. European guidelines recommend that reperfusion therapy should be considered promptly, preferably using emergency coronary angiography with a view to primary PCI in patients with clinical suspicion of ongoing myocardial ischemia and new or presumed new LBBB.

However, the ACCF/AHA guidelines are much less enthusiastic and recommend that patients with new or presumed new LBBB should not be considered as diagnostic of AMI in isolation and consequently provide little guidance on how to react if biomarkers are elevated. Routine clinical practice documentation of prior ECGs, which would confirm whether the LBBB was new or not, is often missing increasing the uncertainty on how to treat these patients.

MedicalResearch.com: What are the main findings?

Response: Our study using data of 28,421 AMI patients from the AMIS (Acute Myocardial Infarction In Switzerland) Plus Registry, showed that the presence of LBBB identifies a patient subset (n=2295) with a higher baseline cardiovascular risk profile and greater burden of pre-existing cardiovascular diseases and comorbidities. These patients are less likely to receive evidence-based antithrombotic therapy and invasive treatment strategy compared with STE patients. LBBB is associated with a higher incidence of unadjusted in-hospital MACCE, mortality, and cardiogenic shock but had the same adjusted risk of in-hospital death as patients with STE.

Over an almost 20-year timespan, from January 1997 through to June 2016, few changes were seen in baseline characteristics but there was a dramatic increase in the use of percutaneous coronary intervention and a decrease in in-hospital mortality from 22.6% to 11.9% in LBBB patients.

MedicalResearch.com: What should readers take away from your report?

Response: Patients presenting with new or presumably new LBBB are high risk patients for both morbidity and mortality. They deserve closer attention and a more careful assessment. Our study suggests that if there are clinical signs of ongoing myocardial ischemia these patients require an aggressive management strategy.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Further studies are needed to better identify those patients with LBBB who may most benefit from an early invasive treatment strategy in view of emergent revascularization. These should then help to achieve guideline consensus.

MedicalResearch.com: Is there anything else you would like to add?

Response: For a researcher, it is a privilege to be able to work with the data from AMIS Plus, a large real-world registry, which continuously collects data and allows such subgroup and trends analyses.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Left bundle branch block in patients with acute myocardial infarction: presentation, treatment and trends in outcome from 1997 to 2016 in routine clinical practice
Erne, Paul et al.
American Heart Journal , Volume 0 , Issue 0
November 10 2016
DOI: http://dx.doi.org/10.1016/j.ahj.2016.11.003

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on November 16, 2016 by Marie Benz MD FAAD