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Patients With Prolonged Ischemic Chest Pain and Presumed-New Left Bundle Branch Block Have Heterogeneous Outcomes Depending on the Presence of ST-Segment Changes

Cheuk-Kit Wong, MD, FACC^_*,, John K. French, MB, PhD, FACC^_*, Philip E.G. Aylward, MD, FACC, Ralph A.H. Stewart, MD, FACC^_*, Wanzhen Gao, PhD^_*, Paul W. Armstrong, MD, FACC, Frans J.J. Van De Werf, MD, FACC^||, R. John Simes, MD^¶, O. Christopher Raffel, MB^_*, Christopher B. Granger, MD, FACC^#, Robert M. Califf, MD, FACC^#, Harvey D. White, DSc, FACC^_*,_* for the HERO-2 Trial Investigators

^_* Cardiovascular Research Unit, Green Lane Hospital, Auckland, New Zealand
Department of Medical and Surgical Sciences, University of Otago, Dunedin, New Zealand
Cardiology Department, Flinders Medical Centre, Adelaide, South Australia
Department of Medicine, University of Alberta, Edmonton, Canada
^|| Department of Cardiology, Gasthuisberg University Hospital, Leuven, Belgium
^¶ National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, Australia
^# Duke Clinical Research Institute, Durham, North Carolina.

View larger version (97K): [in a new window]   Figure 1 (A) Randomization and (B) 60-min electrocardiograms in a patient in whom concordant ST-segment elevation in lead V5 became discordant ST-segment elevation because the net QRS deflection in lead V5 became negative by 60 min.

View larger version (13K): [in a new window]   Figure 2 Thirty-day mortality in 92 patients with ST-segment changes during left bundle branch block (LBBB) versus matched control patients, and in 208 patients without ST-segment changes during LBBB versus matched control patients.

View larger version (14K): [in a new window]   Figure 3 Nonadjusted 30-day survival curves in 92 patients with either concordant ST-segment elevation or lead V1 to V3 ST-segment depression during left bundle branch block (LBBB), 208 patients without concordant ST-segment elevation or lead V1 to V3 ST-segment depression during LBBB, and 15,340 patients with normal intraventricular conduction (p = 0.029 for normal conduction vs. LBBB without ST-segment changes; p < 0.001 for normal conduction vs. LBBB with ST-segment changes; p = 0.07 for LBBB without ST-segment changes vs. LBBB with ST-segment changes).

View larger version (13K): [in a new window]   Figure 4 Adjusted 30-day survival curves in 92 patients with and 208 patients without concordant ST-segment elevation or lead V1 to V3 ST-segment depression during left bundle branch block (LBBB), and in 15,340 patients with normal intraventricular conduction (p = 0.004 for normal conduction vs. LBBB without ST-segment changes; p = 0.08 for normal conduction vs. LBBB with ST-segment changes; p = 0.002 for LBBB without ST-segment changes vs. LBBB with ST-segment changes).