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2018 ; 6
(ä): e4497
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Prognostic value of new-onset right bundle-branch block in acute myocardial
infarction patients: a systematic review and meta-analysis
#MMPMID29576967
Wang J
; Luo H
; Kong C
; Dong S
; Li J
; Yu H
; Chu Y
PeerJ
2018[]; 6
(ä): e4497
PMID29576967
show ga
BACKGROUND: Patients with acute myocardial infarction (AMI) and bundle-branch
block have poor prognoses. The new European Society of Cardiology guideline
suggests a primary percutaneous coronary intervention strategy when persistent
ischemic symptoms occur in patients with persistent ischemic symptoms and right
bundle-branch block (RBBB), but the level of evidence is not high. In fact, the
presence of RBBB may lead to the misdiagnosis of transmural ischemia and mask the
early diagnosis of ST-elevation myocardial infarction. Moreover, new-onset RBBB
is occasionally caused by AMI. Our study aims to investigate the prognostic value
of new-onset RBBB in AMI. METHODS AND RESULTS: We conducted a meta-analysis of
studies to evaluate the prognostic value of RBBB in AMI patients. Of 914 primary
records, five studies and 874 MI patients were included for meta-analysis.
Compared with previous RBBB, AMI patients with new-onset RBBB had a higher risk
of long-term mortality (RR, 1.66, 95% CI [1.31-2.09], I(2) = 0.0%, p = 0.000, n =
2), ventricular arrhythmia (RR, 4.86, 95% CI [2.10-11.27], I(2) = 0.0%, p =
0.000, n = 3), and cardiogenic shock (RR, 2.76, 95% CI [1.66-4.59], I(2) = 0.0%,
p = 0.000, n = 3), but a lower risk of heart failure (RR, 0.66, 95% CI
[0.52-0.85], I(2) = 2.50%, p = 0.001, n = 4). Compared with AMI patients with
new-onset permanent RBBB, patients with new-onset transient RBBB had a lower risk
of short-term mortality (RR, 0.20, 95% CI [0.11-0.37], I(2) = 44.1%, p = 0.000, n
= 4). CONCLUSION: New-onset RBBB is likely to increase long-term mortality,
ventricular arrhythmia, and cardiogenic shock, but not heart failure in AMI
patients. AMI patients with new-onset transient RBBB have a lower risk of
short-term mortality than those with new-onset permanent RBBB. Revascularization
therapies should be considered when persistent ischemic symptoms occur in
patients with RBBB, especially new-onset RBBB.