| Incidence, clinical characteristics, and prognostic significance of right bundle-branch block in acute myocardial infarction: a study in the thrombolytic era. | |
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MedLine Citation:
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PMID: 9286941 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Whereas the significance of right bundle-branch block (RBBB) in acute myocardial infarction was extensively studied in the prethrombolytic era, a possible change in the overall incidence and meaning of RBBB as a consequence of thrombolytic therapy is not well known. METHODS AND RESULTS: A multicenter, prospective study of 1238 patients consecutively diagnosed with acute myocardial infarction and admitted to three coronary care units was conducted. ECGs during the acute phase and clinical events until discharge and 1-year follow-up were monitored. In the 135 (10.9%) patients in whom RBBB was found, there were 51 (37.8%) new cases, 46 (34.1%) old cases, and 38 (28.1%) cases with an indeterminate time of origin. New RBBB was permanent in 26 and transient in 25 patients. RBBB was isolated in 76 (56%) and bifascicular in the remaining 59 (44%) patients. The following complications were more frequently associated with RBBB than non-RBBB patients: heart failure, 24% versus 46% (P<.001); use of pacemaker because of atrioventricular block, 3.6% versus 11% (P<.001); and 1-year mortality, 17.6% versus 40.7% (P<.001). Early mortality was significantly higher for new RBBB (43.1%, P<.001) than for old (15.5%) and indeterminate (15.3%) RBBB. These figures for 1-year mortality were 58.8% (P<.001), 35.5 (P<.01), and 23% (NS), respectively. Permanent and transient RBBB had different mortality rates: early mortality, 76% versus 8%, and 1-year mortality, 84% versus 32% (P<.001 for both). For isolated RBBB versus bifascicular block, early mortality was 14.4% versus 40.6%, and 1-year mortality was 30.2% versus 54.2% (P<.05 for both). Multivariate analysis showed an independent prognostic value of RBBB for early and 1-year mortality. CONCLUSIONS: The overall meaning of RBBB in acute myocardial infarction has not changed in the thrombolytic era, although a higher rate of new and transient RBBB and a lower rate of bifascicular block may represent a beneficial effect of thrombolytic therapy. |
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Authors:
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A Melgarejo-Moreno; J Galcerá-Tomás; A Garciá-Alberola; M Valdés-Chavarri; F J Castillo-Soria; E Mira-Sánchez; J Gil-Sánchez; J Allegue-Gallego |
Publication Detail:
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Type: Journal Article; Multicenter Study |
Journal Detail:
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Title: Circulation Volume: 96 ISSN: 0009-7322 ISO Abbreviation: Circulation Publication Date: 1997 Aug |
Date Detail:
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Created Date: 1997-09-22 Completed Date: 1997-09-22 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1139-44 Citation Subset: AIM; IM |
Affiliation:
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Hospital Virgen del Rosell de Cartagena, Murcia, Spain. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Bundle-Branch Block / epidemiology, etiology*, mortality Female Humans Incidence Logistic Models Male Middle Aged Myocardial Infarction / complications*, drug therapy, mortality Prognosis Prospective Studies Risk Factors Streptokinase / therapeutic use Thrombolytic Therapy Tissue Plasminogen Activator / therapeutic use |
| Chemical | |
Reg. No./Substance:
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EC 3.4.-/Streptokinase; EC 3.4.21.68/Tissue Plasminogen Activator |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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