Prognostic Significance of Right Bundle-Branch Block Associated with Acute ST Elevation Myocardial Infarction.

Right bundle-branch block (RBBB) during acute ST elevation. Known about how RBBB influences the prognosis of acute STEMI in the background of changing demography. The main objective of the study was to determine the prognostic significance of RBBB in acute STEMI patients. This prospective observational study was performed in the National Institute of Cardiovascular Diseases (NICVD), Dhaka from August 2015 to September 2016. Total 216 patients with acute STEMI were included in this study who presented within 12 hours of chest pain. All patients received thrombolysis. In Group I, 108 patients were included with RBBB and another 108 patients without RBBB were included in Group II. Mean age of Group I and Group II were 54.31±10.35 and 51.34±8.98 respectively. Male female ratio was 4.4 and 3.5 in Group I and Group II respectively. In patients with Group I and Group II in-hospital mortality was 20.4% versus 7.5% (p=0.006). The following complications were more frequently associated with Group I acute heart failure (Killip class II) 27.8% versus 13% (p.007), cardiogenic shock 16.7% versus 7.5% (p=.03), ventricular tachycardia 14.8% versus 6.5% (p=0.04), third-degree atrioventricular block 11.1% versus 4.6% (p<0.05), use of temporary pacemaker was in 9.3% versus 2.85% (p<0.05). Logistic regression analysis showed RBBB was independent factor associated with in-hospital mortality (RR 1.96, p=0.002). Acute STEMI patients with RBBB had higher in-hospital mortality compared with acute STEMI patients without RBBB. Complications such as acute heart failure, cardiogenic shock, ventricular tachycardia, third-degree atrioventricular block and use of temporary pacemaker were more common in RBBB of acute STEMI patients. RBBB in acute anterior STEMI was an independent predictor for in-hospital mortality in the multivariate analysis of this study.