Key result
Bundle branch block on admission ECG in acute myocardial infarction was associated with higher cardiogenic shock development than STEMI (12.1% vs 6.7%, p<0.001), with right bundle branch block predicting the highest 1-year mortality (66.7%).
Why the study?
Does the initial ECG pattern predict the development of cardiogenic shock and one-year mortality in patients with acute myocardial infarction?
Cohort (n=5,572)
Yes
Does the initial ECG pattern predict the development of cardiogenic shock and one-year mortality in patients with acute myocardial infarction?
Absolute Event Rate: 12.1% vs 6.7%
p-value: p=<0.001
Right bundle branch block (RBBB) on admission ECG in acute myocardial infarction is a strong independent predictor of cardiogenic shock development and one-year mortality.
May warrant closer monitoring for shock in AMI with bundle branch block; leaves open whether ECG findings should guide interventions without prospective validation.
OBJECTIVES: To assess the relation between initial ECG findings, presence of risk factors, coronary angiography findings, and clinical outcomes in patients with acute myocardial infarction complicated by cardiogenic shock (CS). DESIGN: Data from a total of 5572 acute myocardial infarction patients admitted to the four tertiary hospitals during a period of 3 years were analyzed. CS on admission was present in 358 patients (6.4%). They were divided into four groups based on the admission ECG: ST-segment elevation (STEMI), ST-segment depression (STDMI), bundle branch block (BBBMI), and other ECG acute myocardial infarction. RESULTS: CS developed most frequently among BBBMI patients (in 12.1% of all BBBMIs, p < 0.001 vs. STEMI), followed by STEMI (6.7%), STDMI (4.4%), and other ECG acute myocardial infarction (2.3%). The risk of CS development was similar in patients with left bundle branch block (LBBB) (13.3%) and right bundle branch block (RBBB) (11.2%). The one-year mortality was highest among RBBBMI patients (66.7%, p < 0.001), followed by LBBBMI (48.6%), other ECG (47.1%), STEMI (41.7%), and STDMI patients (38.1%). CONCLUSIONS: RBBB on admission ECG is associated with the highest risk of CS development, frequent left main coronary artery affection, and unsuccessful revascularization. It is also an independent predictor of one-year mortality.
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Jakl et al. (2013) conducted a cohort in Acute myocardial infarction complicated by cardiogenic shock (n=5,572). Bundle branch block on initial ECG vs. ST-segment elevation (STEMI) was evaluated on Cardiogenic shock development (p=<0.001). Bundle branch block on admission ECG in acute myocardial infarction was associated with higher cardiogenic shock development than STEMI (12.1% vs 6.7%, p<0.001), with right bundle branch block predicting the highest 1-year mortality (66.7%).
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