RBBB is linked to similar MI risk vs no block at all

  • Neumann JT & al.
  • Eur Heart J Acute Cardiovasc Care
  • 26 Oct 2018

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • Among patients with suspected myocardial infarction (MI):
    • Right bundle branch block (RBBB) incidence is low;
    • MI likelihood is similar with RBBB vs no bundle branch block (BBB); and
    • RBBB is not associated with increased mortality after adjusted analysis. 
  • Authors: “our data do not support an urgent coronary angiography in patients with RBBB and suspected MI in the absence of ST-segment elevation, hence questioning the diagnostic criteria of RBBB alone as a ST-segment elevation equivalent.”

Why this matters

  • Based on 1 study,  2017 European Society of Cardiology (ESC) guidelines recommend RBBB trigger urgent angiography for patients with ST-elevation MI (STEMI). 
  • Unclear if applicable to emergency department, suspected MI. 

Key results

  • 3.1% (125) had RBBB, 6.9% (281) left BBB (LBBB), and 1.5% (60) bifascicular block (BFB).
  • 20.8% (846/4067) had MI, most non-STEMI.
  • MI incidence:
    • With RBBB: 18.4% (23);
    • With LBBB: 27.0% (76);
    • Without BBB: 20.4% (734). 
  • Median follow-up, 731 days.
  • Adjusted HRs for mortality (95% CIs):
    • RBBB: 1.29 (0.71-2.34; P=.40);
    • LBBB: 1.71 (1.17-2.50; P=.006);
    • BFB: 2.27 (1.28-4.05; P=.005).

Study design

  • Analysis, 2 prospective studies of patients presenting to emergency departments with suspected MI (n=4067). 
  • Final MI diagnosis adjudicated.
  • Outcome: all-cause mortality.
  • Funding: Abbott Diagnostics; German nonprofit organizations.

Limitations

  • Low RBBB rate.

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