Long-term outcomes of left bundle branch block in high-risk survivors of acute myocardial infarction: The VALIANT experience

Kent Stephenson, Hicham Skali, John J.V. McMurray, Eric J. Velazquez, Philip G. Aylward, Lars Kober, Frans Van de Werf, Harvey D. White, Karen S. Pieper, Robert M. Califf, Scott D. Solomon, Marc A. Pfeffer

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23 Citations (Scopus)

Abstract

Background: In survivors of myocardial infarction (MI), new left bundle branch block (LBBB) is associated with adverse outcomes, but its impact is not well described in post-MI patients with left ventricular (LV) systolic dysfunction and/or heart failure (HF). Objectives: The aim of this study was to determine if new LBBB is an independent predictor of long-term fatal and nonfatal outcomes in high-risk survivors of MI by reviewing data from the VALsartan In Acute myocardial iNfarcTion (VALIANT) trial. Methods: In VALIANT, 14,703 patients with LV systolic dysfunction and/or HF were randomized to valsartan, captopril, or both a mean of 5 days after MI. Baseline ECG data were available from 14,259 patients. We assessed the predictive value of new LBBB for death and major cardiovascular outcomes after 3 years, adjusting for multiple baseline covariates including LV ejection fraction. Results: At follow-up, patients with new LBBB (608 [4.2%]) compared with patients without new LBBB had more comorbidities and increased adjusted risk of death (hazard ratio [HR] 1.3, 95% confidence interval [CI] 1.2-1.6), cardiovascular death (HR 1.4, 95% CI 1.2-1.7), HF (HR 1.3, 95% CI 1.1-1.6), MI (HR 1.5, 95% CI 1.2-1.9), and the composite of death, HF, or MI (HR 1.4, 95% CI 1.2-1.6). Conclusion: In post-MI survivors with LV systolic dysfunction and/or HF, new LBBB was an independent predictor of all major adverse cardiovascular outcomes during long-term follow-up. This readily available ECG marker should be considered a major risk factor for long-term cardiovascular complications in high-risk patients after MI.

Original languageEnglish
Pages (from-to)308-313
Number of pages6
JournalHeart Rhythm
Volume4
Issue number3
DOIs
Publication statusPublished - 1 Mar 2007
Externally publishedYes

Keywords

  • Heart failure
  • Left bundle branch block
  • Left ventricular systolic dysfunction
  • Mortality
  • Myocardial infarction

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    Stephenson, K., Skali, H., McMurray, J. J. V., Velazquez, E. J., Aylward, P. G., Kober, L., Van de Werf, F., White, H. D., Pieper, K. S., Califf, R. M., Solomon, S. D., & Pfeffer, M. A. (2007). Long-term outcomes of left bundle branch block in high-risk survivors of acute myocardial infarction: The VALIANT experience. Heart Rhythm, 4(3), 308-313. https://doi.org/10.1016/j.hrthm.2006.11.021