Document Detail

Acute myocardial infarction and complete bundle branch block at hospital admission: clinical characteristics and outcome in the thrombolytic era. GUSTO-I Investigators. Global Utilization of Streptokinase and t-PA [tissue-type plasminogen activator] for Occluded Coronary Arteries.
MedLine Citation:
PMID:  9426026     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: We sought to assess the outcome of patients with acute myocardial infarction (MI) and bundle branch block in the thrombolytic era. BACKGROUND: Studies of patients with acute MI and bundle branch block have reported high mortality rates and poor overall prognosis. METHODS: The North American population with acute MI and bundle branch block enrolled in the Global Utilization of Streptokinase and t-PA [tissue-type plasminogen activator] for Occluded Coronary Arteries (GUSTO-I) trial was matched by age and Killip class with an equal number of GUSTO-I patients without conduction defects. RESULTS: Of all 26,003 North American patients in GUSTO-I, 420 (1.6%) had left (n = 131) or right (n = 289) bundle branch block. These patients had higher 30-day mortality rates than matched control subjects (18% vs. 11%, p = 0.003, odds ratio [OR] 1.8) and were more likely to experience cardiogenic shock (19% vs. 11%, p = 0.008, OR 1.78) or atrioventricular block/asystole (30% vs. 19%, p < 0.012, OR 1.57) and to require ventricular pacing (18% vs. 11%, p = 0.006, OR 1.73). Bundle branch block also carried an independent 53% higher risk for 30-day mortality. Thirty-day mortality rates for patients with complete, partial and no reversion of the bundle branch block were 8%, 12% and 20%, respectively (two-tailed chi-square test for trend 5.61, p = 0.02, OR 0.34 for complete reversion, OR 0.55 for partial reversion). CONCLUSIONS: Bundle branch block at hospital admission in patients with acute MI predicts in-hospital complications and poor short-term survival.
E B Sgarbossa; S L Pinski; E J Topol; R M Califf; A Barbagelata; S G Goodman; K B Gates; C B Granger; D P Miller; D A Underwood; G S Wagner
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  31     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  1998 Jan 
Date Detail:
Created Date:  1998-01-27     Completed Date:  1998-01-27     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  105-10     Citation Subset:  AIM; IM    
Cleveland Clinic Foundation, Ohio, USA.
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MeSH Terms
Bundle-Branch Block / complications*,  mortality
Coronary Angiography
Middle Aged
Myocardial Infarction / complications*,  mortality
Randomized Controlled Trials as Topic
Regression Analysis
Shock, Cardiogenic / complications
Survival Analysis

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