Prognostic significance of bundle-branch block in acute myocardial infarction:: The importance of location and time of appearance

Background: The presence of bundle-branch block (BBB) is associated with high mortality rates and is considered an important predictor of poor outcome in patients with acute myocardial infarction (AMI). Hypothesis: The objective of this study was to assess the prognostic significance of B BE in patients with AMI depending on its form of presentation. Methods: A multicenter prospective 1-year follow-up study involving 1,239 consecutive patients diagnosed with AMI was performed. Results: Bundle-branch block was present in 177 cases (14.2%), associated with worse clinical characteristics, lower rate of thrombolytic therapy, and higher mortality: in-hospital (23.8 vs. 9.7%, p < 0.01) and 1-year (40.9 vs. 16.9%, p < 0.01). Compared with right BBB (n = 135), left BBB (n = 42) was more often associated with female gender and higher prevalence of cardiovascular diseases, but had a similar 1-year mortality. In the absence of heart failure or complete atrioventricular (AV) block, there was no difference in in-hospital mortality of patients with B BE (n = 76) and without BBB (n = 786) (2.6 vs. 3.9%). Compared with existing BBB (n = 113), BBB of new appearance (n = 64) was more often accompanied by complete AV block and heart failure and higher in-hospital and I-year mortality rates. Only BBB of new appearance was an independent predictor of mortality: in-hospital (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.1-4.7) and 1-year mortality (OR 3.2, 95% CI, 1.7-9.1). Conclusions. In patients with AMI, the classification of BBB according not only to location but also to time of appearance is of practical interest. New BBB is an independent predictor of short- and long-term mortality.