Prevalence, Temporal Evolution, and Impact on Survival of Ventricular Conduction Blocks in Patients With Acute Coronary Syndrome and Cardiogenic Shock
Por:
Tolppanen, H, Javanainen, T, Sans-Rosello, J, Parenica, J, Nieminen, T, Pavlusova, M, Masip, J, Kober, L, Banaszewski, M, Sionis, A, Spinar, J, Harjola, VP, Jurkko, R, Lassus, J, CardShock Study Investigators, GREAT Network
Publicada:
15 jul 2018
Resumen:
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. (C) 2018 Elsevier Inc. All rights reserved.
Filiaciones:
Tolppanen, H:
Helsinki Univ Hosp, Heart & Lung Ctr, Helsinki, Finland
Univ Helsinki, Helsinki, Finland
Paijat Hame Cent Hosp, Heart Ctr, Lahti, Finland
Javanainen, T:
Helsinki Univ Hosp, Heart & Lung Ctr, Helsinki, Finland
Univ Helsinki, Helsinki, Finland
Sans-Rosello, J:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Biomed Res Inst IIB St Pau, Intens Cardiac Care Unit,Cardiol Dept, Barcelona, Spain
Parenica, J:
Univ Hosp Brno, Dept Internal Med & Cardiol, Brno, Czech Republic
Nieminen, T:
Helsinki Univ Hosp, Heart & Lung Ctr, Helsinki, Finland
Univ Helsinki, Helsinki, Finland
Helsinki Univ Hosp, Dept Internal Med, Lappeenranta, Finland
Univ Helsinki, South Karelia Cent Hosp, Lappeenranta, Finland
Pavlusova, M:
Univ Hosp Brno, Dept Internal Med & Cardiol, Brno, Czech Republic
Masip, J:
Hosp Sanitas CIMA, Cardiol Dept, Barcelona, Spain
Consorci Sanitari Integral, Dept Intens Care, Barcelona, Spain
Kober, L:
Univ Copenhagen, Rigshosp, Dept Cardiol, Copenhagen, Denmark
Banaszewski, M:
Inst Cardiol, Intens Cardiac Therapy Clin, Warsaw, Poland
Sionis, A:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Biomed Res Inst IIB St Pau, Intens Cardiac Care Unit,Cardiol Dept, Barcelona, Spain
Spinar, J:
Univ Hosp Brno, Dept Internal Med & Cardiol, Brno, Czech Republic
Harjola, VP:
Univ Helsinki, Helsinki, Finland
Helsinki Univ Hosp, Dept Emergency Med & Serv, Helsinki, Finland
Jurkko, R:
Helsinki Univ Hosp, Heart & Lung Ctr, Helsinki, Finland
Univ Helsinki, Helsinki, Finland
Lassus, J:
Helsinki Univ Hosp, Heart & Lung Ctr, Helsinki, Finland
Univ Helsinki, Helsinki, Finland
Green Published
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