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Prevalence, Temporal Evolution, and Impact on Survival of Ventricular Conduction Blocks in Patients With Acute Coronary Syndrome and Cardiogenic Shock
H. Tolppanen, T. Javanainen, J. Sans-Rosello, J. Parenica, T. Nieminen, M. Pavlusova, J. Masip, L. Köber, M. Banaszewski, A. Sionis, J. Spinar, VP. Harjola, R. Jurkko, J. Lassus, CardShock study investigators and for the GREAT Network,
Language English Country United States
Document type Journal Article, Observational Study, Research Support, Non-U.S. Gov't
NLK
ProQuest Central
from 2012-08-15 to 2 months ago
Nursing & Allied Health Database (ProQuest)
from 2012-08-15 to 2 months ago
Health & Medicine (ProQuest)
from 2012-08-15 to 2 months ago
- MeSH
- Acute Coronary Syndrome complications mortality physiopathology MeSH
- Bundle-Branch Block epidemiology etiology physiopathology MeSH
- Adult MeSH
- Electrocardiography * MeSH
- Shock, Cardiogenic complications mortality physiopathology MeSH
- Coronary Angiography MeSH
- Middle Aged MeSH
- Humans MeSH
- Survival Rate trends MeSH
- Follow-Up Studies MeSH
- Prevalence MeSH
- Heart Conduction System physiopathology MeSH
- Prospective Studies MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Heart Ventricles physiopathology MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Observational Study MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Czech Republic MeSH
Changes in QRS duration and pattern are regarded to reflect severe ischemia in acute coronary syndromes (ACS), and ventricular conduction blocks (VCBs) are recognized high-risk markers in both ACS and acute heart failure. Our aim was to evaluate the prevalence, temporal evolution, association with clinical and angiographic parameters, and impact on mortality of VCBs in ACS-related cardiogenic shock (CS). Data of 199 patients with ACS-related CS from a prospective multinational cohort were evaluated with electrocardiogram data from baseline and day 3. VCBs including left or right bundle branch block, right bundle branch block and hemiblock, isolated hemiblocks, and unspecified intraventricular conduction delay were assessed. Fifty percent of patients had a VCB at baseline; these patients were older, had poorer left ventricular function and had more often left main disease compared with those without VCB. One-year mortality was over 2-fold in patients with VCB compared with those without VCB (68% vs 32%, p<0.001). All types of VCBs at baseline were associated with increased mortality, and the predictive value of a VCB was independent of baseline variables and coronary angiography findings. Interestingly, 37% of the VCBs were transient, i.e., disappeared before day 3. However, 1-year mortality was much higher in these patients (69%) compared to patients with persistent (38%) or no VCB (15%, p<0.001). Indeed, a transient VCB was a strong independent predictor of 1-year mortality. In conclusion, our findings propose that any VCB in baseline electrocardiogram, even if transient, identifies very early patients at particularly high mortality risk in ACS-related CS.
Cardiology Department Hospital Sanitas CIMA Barcelona Spain
Department of Cardiology Rigshospitalet University of Copenhagen Copenhagen Denmark
Department of Intensive Care Consorci Sanitari Integral Barcelona Spain
Department of Internal Medicine and Cardiology University Hospital Brno Brno Czech Republic
Heart and Lung Center Helsinki University Hospital and Helsinki University Helsinki Finland
Heart Center Päijät Häme Central Hospital Lahti Finland
Intensive Cardiac Therapy Clinic Institute of Cardiology Warsaw Poland
References provided by Crossref.org
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