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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

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

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

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