![]() ![]() Of 277 evaluated borderline EGCs, 66 ECGs were reclassified as NIVCD (> 119 ms).Įlectrocardiographic recordings were included if they were taken at least 7 days prior to or a maximum of 2 months after the angiography, using the most recent ECG recording. Furthermore, all patients with borderline QRS duration (QRS > 117 ms) classified as NIVCD by the algorithm were manually checked for the presence of QRS > 119 ms by two independent physicians (R.L. The presence of these features was extracted by using the automatic Marquette detection algorithm, which applies the Minnesota classification for intraventricular conduction disorders. To date, the largest study exposing the mortality of NIVCD patients with chronic coronary syndromes was the Multicenter Unsustained Tachycardia Trial, 13 which only included patients with a left ventricular ejection fraction (LVEF) of 119 ms for NIVCD was used so that the IVCD groups would be as comparable as possible with each other, since the same QRS duration criteria are used for LBBB and RBBB. ![]() 8, 10 Although preliminary data from the revascularization era suggested that this type of block carried the highest risk of cardiac death in ACS, 10 its prognostic value has been neglected in subsequent major studies exploring bundle branch blocks in the revascularization era. 7–9Įxtensive ischaemic damage beyond the main branches of the cardiac conduction system results in a block that is typical of neither LBBB nor RBBB and is referred to as a non-specific intraventricular conduction delay (NIVCD) or a peri-infarction block. 3, 4 However, the prognostic value of bundle branch blocks complicating ACS has been mostly derived from either the thrombolytic 3, 5, 6 or the early PCI era with no routine invasive evaluation. 1 Extending electrocardiographic (ECG) interpretation beyond the analysis of ST-T changes has an important role in the recognition of patients with a higher risk of mortality, 2 and those with bundle branch blocks, with right (RBBB) and left bundle branch block (LBBB) in particular, are at the highest risk from all ECG presentations of ACS. The treatment of acute coronary syndromes (ACS) changed dramatically when percutaneous coronary intervention (PCI) replaced thrombolysis as the preferred reperfusion therapy, and the mortality rates related to ACS have continued to decrease during the past two decades. Intraventricular conduction delay, Left bundle branch block, Right bundle branch block, Acute coronary syndrome, Acute myocardial infarction, Unstable angina pectoris, Non–ST-elevation myocardial infarction, ST-elevation myocardial infarction Introduction ![]() After adjusting the analysis with left ventricular ejection fraction, RBBB and NIVCD remained significant risk factors for cardiac mortality. ![]() In an analysis adjusted for age and cardiac comorbidities, the risk of cardiac mortality was significantly higher in all IVCD groups than among patients with no IVCD: SDH 1.37 (1.15–1.64, P < 0.0001) for RBBB, SDH 1.63 (1.31–2.03 P < 0.0001) for LBBB, and SDH 2.68 (2.19–3.27) for NIVCD. The median follow-up time was 6.1 years, during which 3156 patients died. The mean age of the population was 68.3 years. The risk associated with IVCDs was analysed by calculating subdistribution hazard estimates (SDH deaths due to other causes being considered competing events). Mortality and cause of death data (in ICD-10 format) were received from the Finnish national register with no losses to follow-up (until 31 December 2020). The primary outcome was cardiac mortality. This is a retrospective registry analysis of 9749 consecutive ACS patients undergoing coronary angiography and with an electrocardiographic (ECG) recording available for analysis (2007–18). ![]()
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