Key result
Killip class III-IV is linked to ~3.9-fold higher in-hospital mortality in anterior STEMI with RBBB.
Why the study?
AW-STEMI with RBBB signals extensive septal ischemia and may portend higher in-hospital risk despite contemporary PPCI, but in-hospital outcomes and mortality predictors are not well defined.
Cross-Sectional (n=130)
No
In patients with anterior wall STEMI and right bundle branch block, early mortality is strongly driven by cardiogenic shock, older age, and treatment delays, highlighting the need to minimize total ischemic time and achieve excellent reperfusion.
Background: Anterior wall ST-segment elevation myocardial infarction (AW-STEMI) with right bundle branch block (RBBB) signals extensive septal ischemia and may portend higher in-hospital risk despite contemporary primary percutaneous coronary intervention (PPCI). Objective: To estimate in-hospital outcomes and identify bedside predictors of mortality among patients with AW-STEMI and RBBB treated with PPCI in a standardized care pathway. Methods: We performed a descriptive cross-sectional study at a tertiary cardiac center using consecutive enrollment over six months. Adults (≥18 years) with AW-STEMI and RBBB undergoing PPCI within 24 hours were included; prior MI/CABG, significant valvular disease/cardiomyopathy, or refusal of consent were exclusions. Prespecified outcomes were abstracted via a standardized case-report form. Continuous data are reported as mean (SD) or median (IQR); categorical data as n/N (%). A parsimonious multivariable logistic model (events-per-parameter constrained) explored predictors of in-hospital mortality. Results: Of 146 activations, 130/146 (89.0%) met criteria (mean age 58.7 ± 11.8 years; male 104/130 [80.0%]). Median symptom-to-door time was 180 minutes (IQR 120–300); door-to-balloon 78 minutes (62–94), with >90 minutes in 39/130 (30.0%). Culprit was LAD in 120/130 (92.3%); proximal LAD 77/130 (59.2%). Pre-PCI TIMI 0 occurred in 89/130 (68.5%); post-PCI TIMI 3 in 117/130 (90.0%). In-hospital mortality was 12/130 (9.2%; 95% CI, 4.9–15.6). MACE occurred in 20/130 (15.4%; 9.7–22.8); reinfarction 5/130 (3.8%); stroke 3/130 (2.3%); VT/VF 14/130 (10.8%); complete heart block requiring pacing 11/130 (8.5%); acute heart failure 24/130 (18.5%); mechanical circulatory support 11/130 (8.5%). Median length of stay was 4 days (3–6). Killip III–IV independently predicted mortality (adjusted OR 3.85; 95% CI, 1.32–11.25); age per decade showed a moderate association (1.62; 1.08–2.64); symptom-to-door >180 minutes trended toward harm (2.27; 0.78–6.55). Model performance was fair (AUC 0.79; 95% CI, 0.68–0.90). Conclusion: In AW-STEMI with RBBB, in-hospital risk concentrates among patients with shock physiology, older age, and treatment delays, and is mitigated when post-PCI TIMI 3 flow is achieved. System strategies to compress total ischemic time, prioritize early hemodynamic stabilization, and ensure meticulous reperfusion may reduce near-term mortality in this high-risk phenotype.
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Bacha et al. (2025) conducted a cross-sectional in Anterior Wall ST-Segment Elevation Myocardial Infarction with Right Bundle Branch Block (n=130). Anterior wall STEMI with right bundle branch block was evaluated on In-hospital all-cause mortality (95% CI 4.9-15.6). In patients with anterior wall STEMI and right bundle branch block undergoing primary percutaneous coronary intervention, in-hospital mortality was 9.2%, with Killip class III-IV serving as a strong independent predictor of death (aOR 3.85).
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