Acute myocardial infarction and complete bundle branch block at hospital admission: clinical characteristics and outcome in the thrombolytic era. GUSTO-I Investigators. Global Utilization of Streptokinase and t-PA [tissue-type plasminogen activator] for Occluded Coronary Arteries

J Am Coll Cardiol. 1998 Jan;31(1):105-10. doi: 10.1016/s0735-1097(97)00446-4.


Objectives: We sought to assess the outcome of patients with acute myocardial infarction (MI) and bundle branch block in the thrombolytic era.

Background: Studies of patients with acute MI and bundle branch block have reported high mortality rates and poor overall prognosis.

Methods: The North American population with acute MI and bundle branch block enrolled in the Global Utilization of Streptokinase and t-PA [tissue-type plasminogen activator] for Occluded Coronary Arteries (GUSTO-I) trial was matched by age and Killip class with an equal number of GUSTO-I patients without conduction defects.

Results: Of all 26,003 North American patients in GUSTO-I, 420 (1.6%) had left (n = 131) or right (n = 289) bundle branch block. These patients had higher 30-day mortality rates than matched control subjects (18% vs. 11%, p = 0.003, odds ratio [OR] 1.8) and were more likely to experience cardiogenic shock (19% vs. 11%, p = 0.008, OR 1.78) or atrioventricular block/asystole (30% vs. 19%, p < 0.012, OR 1.57) and to require ventricular pacing (18% vs. 11%, p = 0.006, OR 1.73). Bundle branch block also carried an independent 53% higher risk for 30-day mortality. Thirty-day mortality rates for patients with complete, partial and no reversion of the bundle branch block were 8%, 12% and 20%, respectively (two-tailed chi-square test for trend 5.61, p = 0.02, OR 0.34 for complete reversion, OR 0.55 for partial reversion).

Conclusions: Bundle branch block at hospital admission in patients with acute MI predicts in-hospital complications and poor short-term survival.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Bundle-Branch Block / complications*
  • Bundle-Branch Block / mortality
  • Coronary Angiography
  • Female
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / complications*
  • Myocardial Infarction / mortality
  • Randomized Controlled Trials as Topic
  • Regression Analysis
  • Shock, Cardiogenic / complications
  • Survival Analysis