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Clinical characteristics and outcomes of acute coronary syndrome patients with left anterior hemiblock.
Heart. 2014 Sep 15; 100(18):1456-61.H

Abstract

OBJECTIVE

We aimed to study the relationships between left anterior hemiblock (LAHB) and the patient characteristics, management, and clinical outcomes in the setting of acute coronary syndromes (ACS).

METHODS

Admission ECGs of patients enrolled in the Global Registry of Acute Coronary Events (GRACE) ECG substudy, and the Canadian ACS Registry I, were analysed independently at a blinded core laboratory. Multivariable logistic regression analysis was performed to assess the independent associations between LAHB on the admission ECG and in-hospital and 6-month mortality.

RESULTS

Of the 11 820 eligible ACS patients, 692 (5.9%) patients had LAHB. The presence of LAHB on admission was associated with older age, male sex, prior myocardial infarction, prior heart failure, worse Killip class, higher creatinine level, and higher GRACE risk score (all p<0.01). Patients with LAHB less frequently underwent cardiac catheterisation, coronary revascularisation or reperfusion therapy (all p<0.05). The LAHB group had higher in-hospital (6.9% vs 3.9%, p<0.001) and 6-month mortality (12.5% vs 7.7%, p<0.001). However, after adjusting for the known predictors of mortality in the GRACE risk models, LAHB was not independently associated with in-hospital death (OR 1.07, 95% CI 0.76 to 1.52, p=0.70), or death at 6 months (OR 1.00, 95% CI 0.75 to 1.34, p=0.99).

CONCLUSIONS

Across the broad spectrum of ACS, LAHB was associated with significant comorbidities, high-risk clinical features on presentation, and worse unadjusted outcomes. However, LAHB was not an independent predictor of in-hospital and 6-month mortality and did not carry incremental prognostic value beyond the known prognosticators in the GRACE risk models.

Authors+Show Affiliations

St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada Canadian Heart Research Centre, Toronto, Ontario, Canada.Hopital Bichat, Assistance Publique, Hopitaux de Paris, Paris, France.Grochowski Hospital, Warsaw, Poland.Hospital Universitario La Paz, Madrid, Spain.St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.McGill University Health Centre, Montreal, Quebec, Canada.St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.Vancouver General Hospital and University of British Columbia, Vancouver, British Columbia, Canada.Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada Keenan Research Centre, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24842872

Citation

Zhang, Hanfei, et al. "Clinical Characteristics and Outcomes of Acute Coronary Syndrome Patients With Left Anterior Hemiblock." Heart (British Cardiac Society), vol. 100, no. 18, 2014, pp. 1456-61.
Zhang H, Goodman SG, Steg GP, et al. Clinical characteristics and outcomes of acute coronary syndrome patients with left anterior hemiblock. Heart. 2014;100(18):1456-61.
Zhang, H., Goodman, S. G., Steg, G. P., Budaj, A., Lopez-Sendon, J., Dorian, P., Huynh, T., Mangat, I., Wong, G. C., Spencer, F. A., & Yan, A. T. (2014). Clinical characteristics and outcomes of acute coronary syndrome patients with left anterior hemiblock. Heart (British Cardiac Society), 100(18), 1456-61. https://doi.org/10.1136/heartjnl-2014-305708
Zhang H, et al. Clinical Characteristics and Outcomes of Acute Coronary Syndrome Patients With Left Anterior Hemiblock. Heart. 2014 Sep 15;100(18):1456-61. PubMed PMID: 24842872.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical characteristics and outcomes of acute coronary syndrome patients with left anterior hemiblock. AU - Zhang,Hanfei, AU - Goodman,Shaun G, AU - Steg,Gabriel P, AU - Budaj,Andrzej, AU - Lopez-Sendon,Jose, AU - Dorian,Paul, AU - Huynh,Thao, AU - Mangat,Iqwal, AU - Wong,Graham C, AU - Spencer,Frederick A, AU - Yan,Andrew T, AU - ,, AU - ,, Y1 - 2014/05/19/ PY - 2014/5/21/entrez PY - 2014/5/21/pubmed PY - 2014/10/17/medline SP - 1456 EP - 61 JF - Heart (British Cardiac Society) JO - Heart VL - 100 IS - 18 N2 - OBJECTIVE: We aimed to study the relationships between left anterior hemiblock (LAHB) and the patient characteristics, management, and clinical outcomes in the setting of acute coronary syndromes (ACS). METHODS: Admission ECGs of patients enrolled in the Global Registry of Acute Coronary Events (GRACE) ECG substudy, and the Canadian ACS Registry I, were analysed independently at a blinded core laboratory. Multivariable logistic regression analysis was performed to assess the independent associations between LAHB on the admission ECG and in-hospital and 6-month mortality. RESULTS: Of the 11 820 eligible ACS patients, 692 (5.9%) patients had LAHB. The presence of LAHB on admission was associated with older age, male sex, prior myocardial infarction, prior heart failure, worse Killip class, higher creatinine level, and higher GRACE risk score (all p<0.01). Patients with LAHB less frequently underwent cardiac catheterisation, coronary revascularisation or reperfusion therapy (all p<0.05). The LAHB group had higher in-hospital (6.9% vs 3.9%, p<0.001) and 6-month mortality (12.5% vs 7.7%, p<0.001). However, after adjusting for the known predictors of mortality in the GRACE risk models, LAHB was not independently associated with in-hospital death (OR 1.07, 95% CI 0.76 to 1.52, p=0.70), or death at 6 months (OR 1.00, 95% CI 0.75 to 1.34, p=0.99). CONCLUSIONS: Across the broad spectrum of ACS, LAHB was associated with significant comorbidities, high-risk clinical features on presentation, and worse unadjusted outcomes. However, LAHB was not an independent predictor of in-hospital and 6-month mortality and did not carry incremental prognostic value beyond the known prognosticators in the GRACE risk models. SN - 1468-201X UR - https://www.unboundmedicine.com/medline/citation/24842872/Clinical_characteristics_and_outcomes_of_acute_coronary_syndrome_patients_with_left_anterior_hemiblock_ L2 - https://heart.bmj.com/lookup/pmidlookup?view=long&amp;pmid=24842872 DB - PRIME DP - Unbound Medicine ER -