Prevalence, incidence and prognostic implications of left bundle branch block in patients with stable coronary artery disease. An analysis from the CLARIFY registry - 06/01/20
Résumé |
Background |
The prevalence, and prognostic implication of left bundle branch block (LBBB) patients with stable coronary artery disease (CAD) is unknown.
Purpose |
To describe the prevalence, incidence and prognostic implications of LBBB in patients with stable CAD.
Methods |
CLARIFY is an international registry of more than 30.000 patients with stable CAD. LBBB was defined as a QRS complex>120 milliseconds. Patients with previous pacemaker implantation or defibrillator were excluded. The primary outcome was a composite of cardiovascular (CV) Death, MI or stroke, and secondary outcomes included hospitalization for heart failure (HF) or the need for pacemaker implantation.
Results |
From the 23.457 patients with available data, 1.041 (4.4%) had LBBB at baseline and 1.237 (5.3%) during 5-year follow-up. Only 21 patients with newly diagnosed LBBB overtime, had a documented MI the same year. Compared to patients without LBBB, patients with LBBB had a higher risk profile regarding age (67.2±10.1 versus 63.6±10.4 years, P<0.0001), history of coronary artery bypass grafting (29.2% vs. 23.7%, P<0.0001), diabetes (35.1% vs. 28.4%, P<0.0001), and HF (25.2% vs. 16.8%, P<0.0001). In multivariate analysis there was no difference in the rate of primary outcome between LBBB or no-LBBB patients (adjusted HR 1.04, 95% CI 0.85–1.29). Patients with LBBB had a higher rate of pacemaker implantation (adjusted HR 2.21, 95% CI 1.55–3.15, P<0.0001) and hospitalization for HF (adjusted HR 1.53, 95% CI 1.25–1.88, P<0.0001) (Table 1, Fig. 1).
Conclusion |
The prevalence of LBBB in patients with stable CAD was 4.4% and 5.3% with 5-year follow-up. The majority of newly diagnosed LBBB were not contemporary of myocardial infarction. LBBB was not associated with a higher rate of major adverse cardiovascular events, but with a higher risk of pacemaker implantation and hospitalization for heart failure. This is the first study reporting such results in a broad population of stable CAD patients.
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Vol 12 - N° 1
P. 107-108 - janvier 2020 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.