Key result
The specific subtype and timing of bundle-branch block (new-onset vs old, RBBB vs LBBB) was not independently associated with the severity of coronary lesions as assessed by the SYNTAX score.
Why the study?
The clinical features and severity of CAD associated with subtypes of bundle-branch block, based on time of appearance, are not well characterized in patients without known CAD.
Are different subtypes and timings of bundle-branch block associated with the severity of coronary atherosclerosis in patients with suspected CAD?
Cohort (n=243)
Yes
Are different subtypes and timings of bundle-branch block associated with the severity of coronary atherosclerosis in patients with suspected CAD?
In patients with suspected CAD, the specific subtype or new onset of bundle-branch block does not independently correlate with the anatomic severity of coronary atherosclerosis.
Answers are grounded in this paper and cite their sources.
BBB subtype and timing should not guide CAD severity assessment; leaves open prognostic roles beyond anatomy in suspected cases.
BACKGROUND: Right bundle-branch block (RBBB) and left bundle-branch block (LBBB) play a role in the pathogenesis and progression of coronary artery disease (CAD). However, the clinical features and the severity of coronary artery disease associated with different subtypes of bundle-branch block, according to time of new appearance, is not well characterized in patients with no known CAD. METHODS: We retrospectively analyzed data pertaining to consecutive patients with RBBB or LBBB who underwent coronary angiography. The severity of coronary lesions was evaluated using the SYNTAX score. The differential effect of new-onset RBBB, old RBBB, new-onset LBBB, and old LBBB on the severity of CAD and its association with clinical characteristics was quantified. Multivariate logistic regression analysis was performed to evaluate the effect of RBBB and LBBB on the degree of coronary atherosclerosis in patients without known CAD. RESULTS: Out of the 243 patients, 72 patients had old LBBB, 37 had new-onset LBBB, 93 patients had old RBBB, and 41 patients had new-onset RBBB. On univariate analysis, age, systolic blood pressure, diastolic blood pressure, creatinine, serum glucose, and glycosylated hemoglobin level were associated with high SYNTAX score (p < .05 for all). Patients in the new-onset RBBB, old RBBB, new-onset LBBB, and old LBBB groups showed significant differences in baseline characteristics and coronary atherosclerosis (p < .05 for all). However, there were no significant between-group differences with respect to the degree of coronary atherosclerosis as assessed by SYNTAX score. CONCLUSIONS: New-onset RBBB, old RBBB, new-onset LBBB, and old LBBB were not associated with the severity of coronary lesions as assessed by SYNTAX score in patients without known CAD.
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Zhu et al. (2021) conducted a cohort in Suspected coronary artery disease with bundle-branch block (n=243). Bundle-branch block subtypes (new-onset RBBB, old RBBB, new-onset LBBB, old LBBB) vs. Between-group comparison was evaluated on Severity of coronary atherosclerosis assessed by SYNTAX score (p=>0.05). The specific subtype and timing of bundle-branch block (new-onset vs old, RBBB vs LBBB) was not independently associated with the severity of coronary lesions as assessed by the SYNTAX score.
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