Prognostic Value of Left Bundle Brunch Block in Patients With Acute Coronary Syndrome
Aim: to assess rognostic value of ECG signs of left bundle brunch block (LBBB) using database of registries of acute coronary syndromes (ACS) RECORD 1 (2007-2008) and 2 (2009-2011). Material and methods. Total number of included patients was 2452, 2321 patients (94.9%) had no signs of LBBB, for 5 patients (0.2%) there was no information on the presence of LBBB. Among 126 patients (5.1 %) with LBBB it was designated as «new» in 72 (2.9%), «old» in 39 (1.6%), and of "unknown duration" in 15 (0.6%) patients. For further analysis we combined patients with "new" and «unknown duration» LBBB (n=87 [3.5%]). Among these patients 43 (49.5%) were considered as having ST elevation (STE) and 44 (50/5%) - non STE ACS. Results. Patients with LBBB were significantly older, had more concomitant diseases, more severe course of ACS, and higher GRACE score. Patients with new LBBB irrespective of ACS type significantly less often received active drug therapy while reperfusion therapy was significantly less often used in patients with LBBB and diagnosed STE myocardial infarction. Unfavorable events such as cardiogenic shock, death, death and myocardial infarction during hospitalization occurred more often among patients with STEACS and new LBBB. Conclusion. Patients with ECG signs of LBBB at the background of ACS were characterized by severe clinical course of the disease and have unfavorable short term prognosis. However quality of hospital care of these patients was significantly worse compared with average quality of care of patients with ACS without LBBB.