| Background:Many studies had shown that acute myocardial infarction( AMI) complicated with Right Bundle Branch Block(RBBB) is often the performance of the massive myocardial infarction, which had high incidence of malignant arrhythmias and badly damaged heart function, it was also an independent predictor of poor prognosis in the near future. Timely opening the blood vessels of crime by percutaneous coronary intervention( PCI) could improve the long-term prognosis in those patients.But the prognosis of ST-elevation myocardial infarction(STEMI) patients merged with emergency PCI is seldom reported, and the influence on prognosis due to BBB type was unclear.Objective: We studied the clinical data, cardiac function, incidence of malignant arrhythmias and mortality in STEMI patients for emergency PCI, and explored the short and medium term prognosis of Bundle Branch Block on emergency PCI for STEMI patients.Method: 1.We studied 366 consecutive patients who admitted to the First Affiliated Hospital of Soochow University with acute ST-segment elevation myocardial infarction for emergency PCI from May 2011 to April 2014. The patients were divided into four groups: group 1 includes 249 patients with STEMI(males 207,83.1%); group 2 includes 48 STEMI patients with left bundle branch block(LBBB)(males 39,81.3%); group 3 includes 69 STEMI patients with right bundle branch block(RBBB)(males 61,88.4%); group 4 includes group 2 and group 3,a total of 117 patients(males 100,85.5%).2. The retrospective study was to collect clinical data of selected patients, such as age, gender, history of smoking, history of hypertension, history of diabetes, history of previous myocardial infarction, previous history of CABG, platelet count, MPV, hemoglobin, BUN, creatinine, uric acid, troponin, CRP and so on. We also collected Killip grading of admission, LVEF values, malignant arrhythmia, the postoperative mortality in 30 days and the postoperative mortality in 90 days.3. The relevant data were compared between the group 1 and group 4, and then divided into 3 subgroups were compared: ①Compared the group 1 with group 2; ②compared the group 1 with group 3; ③Compared the group 2 with group 3;And analysis of the relevant factors on the prognosis of patients with STEMI combined with BBB and patients with STEMI after primary PCI.4. This study was explored the short and medium term prognosis of Bundle Branch Block on emergency PCI for STEMI patients by Kaplan- meier survival analysis.Results: 1. More culprit vessels were anterior descending and right coronary lesions in the simple STEMI group, and a higher incidence of multi vessel lesions in patients with STEMI group with LBBB, culprit vessel distribution between the two groups was statistically significant. More culprit vessels were anterior descending and right coronary lesions in the simple STEMI group, and more culprit vessels was anterior descending lesions in patients with STEMI group with RBBB, culprit vessel distribution between the two groups was statistically significant.2. More single vessel lesions occurred in the simple STEMI group, and more multi vessel lesions occurred in patients with STEMI group with LBBB, the proportion of coronary lesion vessels between the two groups was statistically significant.More single vessel lesions occurred in the simple STEMI group, and more single and double-vessel lesions occurred in patients with STEMI group with RBBB, the proportion of coronary lesion vessels between the two groups was statistically significant.More multi vessel lesions occurred in patients with STEMI group with LBBB, and more single and double-vessel lesions occurred in patients with STEMI group with RBBB, the proportion of coronary lesion vessels between the two groups was statistically significant.3.More anterior or extensive anterior wall and inferior and posterior myocardial infarction occurred in the simple STEMI group, and more anterior or extensive anterior wall myocardial infarction occurred in patients with STEMI and RBBB, the distribution of myocardial infarction between the two groups was statistically significant. More anterior or extensive anterior wall and inferior and posterior myocardial infarction occurred in patients with STEMI and LBBB, and more anterior or extensive anterior wall myocardial infarction occurred in patients with STEMI and RBBB, the distribution of myocardial infarction between the two groups was statistically significant.4.Cardiac function of patients with STEMI group with BBB was significantly lower than that in the simple STEMI group, become statistically significant. By comparing subgroups, cardiac function of patients with STEMI group with LBBB and STEMI group with RBBB were significantly lower than that in the simple STEMI group, become statistically significant. Cardiac function of patients with STEMI group with LBBB was significantly lower than that in STEMI group with RBBB, become statistically significant.5.LVEF in patients with STEMI group with BBB compared with the simple STEMI group, there was no significant difference. By comparing subgroups, LVEF in patients with STEMI group with LBBB was significantly lower than that in patients with STEMI group with RBBB and the simple STEMI group, become statistically significant. But LVEF in patients with STEMI group with RBBB compared with the simple STEMI group, there was no significant difference.6.The incidence of slow arrhythmia, supraventricular arrhythmias and ventricular arrhythmia in patients with STEMI group with BBB was significantly greater than that in the simple STEMI group, become statistically significant. By comparing subgroups, the incidence of slow arrhythmia, supraventricular arrhythmias and ventricular arrhythmia in patients with STEMI group with LBBB and STEMI group with RBBB was significantly greater than that in the simple STEMI group, become statistically significant. The incidence of slow arrhythmia and ventricular arrhythmia in patients with STEMI group with LBBB was significantly greater than that in patients with STEMI group with RBBB, become statistically significant.7. 30 days cumulative survival rate in patients with STEMI group with BBB was significantly lower than that in the simple STEMI group, become statistically significant. By comparing subgroups, 30 days cumulative survival rate in patients with STEMI group with LBBB was significantly lower than that in the simple STEMI group, become statistically significant. But patients with STEMI group with LBBB and the simple STEMI group compared with patients with STEMI group with RBBB, 30 days cumulative survival rate of the two groups were no significant differences.8. 90 days cumulative survival rate in patients with STEMI group with BBB was significantly lower than that in the simple STEMI group, become statistically significant. By comparing subgroups, 90 days cumulative survival rate in patients with STEMI group with LBBB and STEMI group with RBBB were significantly lower than that in the simple STEMI group, become statistically significant. But patients with STEMI group with LBBB compared with patients with STEMI group with RBBB, 90 days cumulative survival rate was no significant differences.Conclusion:1. Patients with STEMI and BBB were older, and had higher rates of history of smoking, hypertension, previous history of MI.2. Compared with patients without BBB, the incidence increased significantly of Left anterior descending artery lesion and multiple vessel disease and anterior or extensive anterior wall myocardial infarction in patients with BBB. There are many heart failure and arrhythmia in patients with BBB, and the short-term prognosis is worse.3. Compared with patients with RBBB, the incidence increased significantly of arrhythmia in patients with LBBB which had Left anterior descending artery lesion and multiple vessel disease and poor heart function. |
PDF Full Text Request