The Relationship of Conduction Disorder and Prognosis in Patients with Acute Coronary Syndrome
Objective. Conduction disorders with a widened QRS are associated with poor prognosis in patients with acute coronary syndrome (ACS). Conduction disorders include left bundle branch block (LBBB), right bundle branch block (RBBB), and nonspecific intraventricular conduction delay (NICD). Previous stu...
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| Format: | Article |
| Language: | English |
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Wiley
2022-01-01
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| Series: | International Journal of Clinical Practice |
| Online Access: | http://dx.doi.org/10.1155/2022/9676434 |
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| author | Wei-Chieh Lee Yen-Nan Fang Tien-Yu Chen Yun-Yu Hsieh Yi-Hsuan Tsai Hsiu-Yu Fang Po-Jui Wu Huang-Chung Chen Ping-Yen Liu |
| author_facet | Wei-Chieh Lee Yen-Nan Fang Tien-Yu Chen Yun-Yu Hsieh Yi-Hsuan Tsai Hsiu-Yu Fang Po-Jui Wu Huang-Chung Chen Ping-Yen Liu |
| author_sort | Wei-Chieh Lee |
| collection | DOAJ |
| description | Objective. Conduction disorders with a widened QRS are associated with poor prognosis in patients with acute coronary syndrome (ACS). Conduction disorders include left bundle branch block (LBBB), right bundle branch block (RBBB), and nonspecific intraventricular conduction delay (NICD). Previous studies did not have conflicting results regarding the type of bundle branch block (BBB) with the worst prognosis, and few studies have focused on the prognosis of patients with NICD. Methods. Patients with ACS were enrolled between January 2005 and December 2019, and their medical history (International Classification of Diseases codes) was obtained from the Chang Gung Research Database. Age, sex, comorbidities, left ventricular ejection fraction (LVEF), and drug use were compared between the patients with and without conduction disorders. The following clinical outcomes were compared between patients with and without conduction disorders: heart failure (HF) hospitalization, cardiovascular (CV) mortality, and all-cause mortality. After propensity score matching, the Kaplan–Meier curve analysis for HF hospitalization, CV mortality, and all-cause mortality were compared among patients with LBBB, RBBB, and NICD. Results. This study enrolled a total of 33970 participants and involved 3392 and 30578 patients with and without conduction disorders, respectively. Older age and a higher prevalence of comorbidities were noted in patients with conduction disorders. Lower mean LVEF was exhibited in the patients with conduction disorders (with vs. without; 44.64 ± 20.73% vs. 49.85 ± 20.63%; p<0.001). During the 3-year follow-up period, higher incidences of HF hospitalization (21.55% vs. 17.51%; p<0.001), CV mortality (17.98% vs. 12.14%; p<0.001), and all-cause mortality (38.86% vs. 31.15%; p<0.001) were noted in the patients with conduction disorder. After ACS events, 10.0% of patients presented with conduction disorders, with LBBB in 3.3%, RBBB in 6.0%, and NICD in 0.7%. The lowest mean of LVEF was presented in the patients with NICD (LBBB vs. RBBB vs. NICD; 41.00 ± 19.47% vs. 47.73 ± 20.82% vs. 34.57 ± 20.02%; p<0.001). Among the three groups, the highest incidence of HF hospitalization was noted in patients with LBBB after propensity score matching. The lowest incidence of CV and all-cause mortality was observed in patients with RBBB. After adjustment of age, gender, comorbidities, medication, and mean LVEF, those with LBBB had the highest hazard ratio for major adverse cardiovascular events (MACEs) of 1.113 (p=0.029; 95% CI = 1.013–1.266). Conclusions. In the ACS population, patients with conduction delay had a poor prognosis due to a higher prevalence of comorbidities and lower mean LVEF. Among the patients with LBBB, RBBB, and NICD, those with LBBB and NICD had a higher incidence of HF hospitalization, CV mortality, and all-cause mortality. Patients with NICD had the lowest mean LVEF compared to those with LBBB and RBBB. Patients with LBBB had a significantly highest HR of MACE. |
| format | Article |
| id | doaj-art-ff71b06e158b4f4285916fb7b01a5e36 |
| institution | Kabale University |
| issn | 1742-1241 |
| language | English |
| publishDate | 2022-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | International Journal of Clinical Practice |
| spelling | doaj-art-ff71b06e158b4f4285916fb7b01a5e362025-02-03T06:08:40ZengWileyInternational Journal of Clinical Practice1742-12412022-01-01202210.1155/2022/9676434The Relationship of Conduction Disorder and Prognosis in Patients with Acute Coronary SyndromeWei-Chieh Lee0Yen-Nan Fang1Tien-Yu Chen2Yun-Yu Hsieh3Yi-Hsuan Tsai4Hsiu-Yu Fang5Po-Jui Wu6Huang-Chung Chen7Ping-Yen Liu8Institute of Clinical MedicineDivision of CardiologyDivision of CardiologyBiostatistics CenterBiostatistics CenterDivision of CardiologyDivision of CardiologyDivision of CardiologyInstitute of Clinical MedicineObjective. Conduction disorders with a widened QRS are associated with poor prognosis in patients with acute coronary syndrome (ACS). Conduction disorders include left bundle branch block (LBBB), right bundle branch block (RBBB), and nonspecific intraventricular conduction delay (NICD). Previous studies did not have conflicting results regarding the type of bundle branch block (BBB) with the worst prognosis, and few studies have focused on the prognosis of patients with NICD. Methods. Patients with ACS were enrolled between January 2005 and December 2019, and their medical history (International Classification of Diseases codes) was obtained from the Chang Gung Research Database. Age, sex, comorbidities, left ventricular ejection fraction (LVEF), and drug use were compared between the patients with and without conduction disorders. The following clinical outcomes were compared between patients with and without conduction disorders: heart failure (HF) hospitalization, cardiovascular (CV) mortality, and all-cause mortality. After propensity score matching, the Kaplan–Meier curve analysis for HF hospitalization, CV mortality, and all-cause mortality were compared among patients with LBBB, RBBB, and NICD. Results. This study enrolled a total of 33970 participants and involved 3392 and 30578 patients with and without conduction disorders, respectively. Older age and a higher prevalence of comorbidities were noted in patients with conduction disorders. Lower mean LVEF was exhibited in the patients with conduction disorders (with vs. without; 44.64 ± 20.73% vs. 49.85 ± 20.63%; p<0.001). During the 3-year follow-up period, higher incidences of HF hospitalization (21.55% vs. 17.51%; p<0.001), CV mortality (17.98% vs. 12.14%; p<0.001), and all-cause mortality (38.86% vs. 31.15%; p<0.001) were noted in the patients with conduction disorder. After ACS events, 10.0% of patients presented with conduction disorders, with LBBB in 3.3%, RBBB in 6.0%, and NICD in 0.7%. The lowest mean of LVEF was presented in the patients with NICD (LBBB vs. RBBB vs. NICD; 41.00 ± 19.47% vs. 47.73 ± 20.82% vs. 34.57 ± 20.02%; p<0.001). Among the three groups, the highest incidence of HF hospitalization was noted in patients with LBBB after propensity score matching. The lowest incidence of CV and all-cause mortality was observed in patients with RBBB. After adjustment of age, gender, comorbidities, medication, and mean LVEF, those with LBBB had the highest hazard ratio for major adverse cardiovascular events (MACEs) of 1.113 (p=0.029; 95% CI = 1.013–1.266). Conclusions. In the ACS population, patients with conduction delay had a poor prognosis due to a higher prevalence of comorbidities and lower mean LVEF. Among the patients with LBBB, RBBB, and NICD, those with LBBB and NICD had a higher incidence of HF hospitalization, CV mortality, and all-cause mortality. Patients with NICD had the lowest mean LVEF compared to those with LBBB and RBBB. Patients with LBBB had a significantly highest HR of MACE.http://dx.doi.org/10.1155/2022/9676434 |
| spellingShingle | Wei-Chieh Lee Yen-Nan Fang Tien-Yu Chen Yun-Yu Hsieh Yi-Hsuan Tsai Hsiu-Yu Fang Po-Jui Wu Huang-Chung Chen Ping-Yen Liu The Relationship of Conduction Disorder and Prognosis in Patients with Acute Coronary Syndrome International Journal of Clinical Practice |
| title | The Relationship of Conduction Disorder and Prognosis in Patients with Acute Coronary Syndrome |
| title_full | The Relationship of Conduction Disorder and Prognosis in Patients with Acute Coronary Syndrome |
| title_fullStr | The Relationship of Conduction Disorder and Prognosis in Patients with Acute Coronary Syndrome |
| title_full_unstemmed | The Relationship of Conduction Disorder and Prognosis in Patients with Acute Coronary Syndrome |
| title_short | The Relationship of Conduction Disorder and Prognosis in Patients with Acute Coronary Syndrome |
| title_sort | relationship of conduction disorder and prognosis in patients with acute coronary syndrome |
| url | http://dx.doi.org/10.1155/2022/9676434 |
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