SHA24/056004

Abdulaziz Joury, Tarek Kashour, Ahmed Hersi, Khalid Alhabib, Husam Alfaleh, King Saud University

• The prevalence of LBBB among patients with acute MI is 2-9% in the Western population • It has been recognized since early 70s of the last century that patient with acute MI and LBBB have worse prognosis 1,2 • Recent studies showed similar findings 3,4

1.Col & Weinberg, Am J Cardiol 1972 2.Hidman et al, Circulation 1978 3.García-García C et al. Am J Cardiol. 2011 4.Sameer Bansilal et al. Am J Cardiol. 2011

• Patients with AMI and LBBB were more likely to present with higher than Killip calss I • Are older • Less likely to receive reperfusion therapy • Less likely to receive beta blockers

Brilakis et al, Am J cardiol 2001

• Even in the reperfusion era, LBBB still carries higher mortality, both: in-hospital mortality and 1-year mortality

Brilakis et al, Am J cardiol 2001

Vivas et al, Am J cardiol 2010

• Only scarce information is available regarding LBBB in ACS patients in our region • It would be imperative upon the investigators from this region to bridge the existing gap • SPACE and GULF-RACE registries were a response to such need

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Assess prevalence of LBBB among patients presenting with ACS Determine clinical correlates of LBBB in ACS patients. and determine treatment profiles and interventions in this patient population

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Assess the influence of LBBB on outcomes of patients presenting with ACS

• A registry-based study “Gulf-RACE-2 “ • Prospective, multicentre study, which recruited 7929 consecutive ACS patients from 6 GCC countries in 65 hospitals • Patients with a diagnosis of ACS (USA,NSTEMI, and STEMI) were recruited

• Diagnosis of ACS was based on the American College of Cardiology guidelines • Case report form for each patient with suspected ACS was initiated upon hospital admission • All CRFs were verified by a cardiologist

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Patient baseline characteristics, clinical presentations, co-morbid conditions, in-hospital treatments, diagnosis, and outcomes were obtained

• All patients with LBBB were identified and included in the study group • LBBB group was compared with the rest of the cohort • Comparisons were analyzed using the appropriate statistical tests

Total “Gulf-RACE II” registry 7929 patients Patients with No-LBBB = 7704 (97.2%) patients

Patients with LBBB = 225 (2.8%) patients

• LBBB patients were older, with mean age of 65± 11.8 years, in comparison to No-LBBB group 56± 12.4 years, p=0.013 • History of angina, MI, congestive heart failure (CHF), chronic renal failure (CRF), valvular heart disease (VHD), prior revascularization and atherosclerosis risk factors were more prevalent among the LBBB patients • All risk factors for CAD except for male gender were more prevalent in the LBBB group

P= <0.001 P= <0.001 P= <0.001 P= 0.020

P= <0.001

All P= <0.001

In-Hospital Treatment

P= <0.001

P= <0.001 P= 0.017 P= 0.038

P= <0.001

P= <0.001

P= 0.002

P= 0.014

Discussion â&#x20AC;˘ The findings of our study are consistent with many previous studies â&#x20AC;˘ However, the age was lower and prevalence of diabetes was higher in our registry compared to other registries

Conclusions • LBBB was present in 2.8% of ACS patients in the GulfRACE-2 registry •

It was associated with older age, more comorbidities and higher Killip class II, III and IV on presentation

• Patients with LBBB were less likely to receive thrombolytic therapy, beta blockers or undergo angiography • LBBB patients had higher in-hospital, 30-day and 1-year mortality

Conclusions â&#x20AC;˘ Interestingly, it seems that there is a lot of room to improve the outcomes of ACS patients with LBBB â&#x20AC;˘ Further studies should focus in exploring the effect of more aggressive therapy in this patients population including revascularization BB and others

Thank You