Muhammad Hashim, Shah Zeb, Ghazanfar Ali Shah, Syed Nadeem Hassan Rizvi.
In-hospital mortality in patients of ST elevation MI presenting with right bundle branch block.
Pak Heart J Jan ;50(4):241-7.

Objective: To determine the frequency of in-hospital mortality of patients having ST elevation MI with right bundle branch block (RBBB) after giving emergency treatment, within 72-hours of hospital admission. Methodology: This observational cross-sectional study was conducted from February to August 2012 in casualty and medical wards at National Institute of Cardiovascular Diseases Karachi. All consecutive patients with ST elevation MI(STEMI) having right bundle branch block were included. In hospital mortality of every patient was assessed during 72-hrs of in-hospital admission. Data regarding age, gender, co-morbidities, type of ST elevation MI, type of emergency treatment and in-hospital mortality were documented. Frequencies and percentages of categorical variables, mean and standard deviation of continuous variables were calculated using SPSS version 17. Results: Out of 120 patients 80.8% were males . Of all the patients 38.3% were diabetic, 35% were hypertensive, 33.3% were smokers and 25.0% were those who had no co morbidities. Acute anterior wall MI was found in 87.5%, inferior wall MI in 6.7% and acute lateral wall MI was found in 3.3% patients while in 2.5%patients both anterior wall and lateral wall MI was found. The mean age of the patients was 56.59+-9.92 years. The mean duration of diabetes and hypertension was 13.72+-6.49 years and 17.12+-.6.96 years respectively.About 75% patients received streptokinase, and 25% were treated with primary PCI. The overall mortality rate was 28(23.3%) patients mostly males 23(82.1%).Mortality was high in 61-70 years age group 16(57.1%) while no mortality was observed in age groups < 40 years. Mortality rate was high in smokers 15(53.6%). Mortality in acute anterior wall myocardial infarction was 27(96.4%)and 01(3.6%) with anterio-lateral wall MI. Mortality rate was very high in patients treated with streptokinase 23(82.1%) as compared to primary PCI (p <0.05). Conclusion: In STEMI, RBBB was an independent predictor of high in-hospital mortality. Patients who have RBBB accompanying anterior AMI at presentation or who develop new BBB early after fibrinolytic therapy independently have higher mortality than patients without these conduction abnormalities

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