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Clinical characteristics and outcomes of acute coronary syndrome patients with left anterior hemiblock
  1. Hanfei Zhang1,
  2. Shaun G Goodman1,2,
  3. Gabriel P Steg3,
  4. Andrzej Budaj4,
  5. Jose Lopez-Sendon5,
  6. Paul Dorian1,
  7. Thao Huynh6,
  8. Iqwal Mangat1,
  9. Graham C Wong7,
  10. Frederick A Spencer8,
  11. Andrew T Yan1,9
  12. on behalf of the Global Registry of Acute Coronary Events (GRACE) ECG Substudy Investigators and the Canadian ACS Registry Investigators
  1. 1St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
  2. 2Canadian Heart Research Centre, Toronto, Ontario, Canada
  3. 3Hopital Bichat, Assistance Publique, Hopitaux de Paris, Paris, France
  4. 4Grochowski Hospital, Warsaw, Poland
  5. 5Hospital Universitario La Paz, Madrid, Spain
  6. 6McGill University Health Centre, Montreal, Quebec, Canada
  7. 7Vancouver General Hospital and University of British Columbia, Vancouver, British Columbia, Canada
  8. 8Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
  9. 9Keenan Research Centre, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
  1. Correspondence to Dr Andrew T Yan, St. Michael's Hospital, Division of Cardiology, 30 Bond Street, Room 6-030 Donnelly, Toronto, Ontario, Canada M5B 1W8; yana{at}


Objective We aimed to study the relationships between left anterior hemiblock (LAHB) and the patient characteristics, management, and clinical outcomes in the setting of acute coronary syndromes (ACS).

Methods Admission ECGs of patients enrolled in the Global Registry of Acute Coronary Events (GRACE) ECG substudy, and the Canadian ACS Registry I, were analysed independently at a blinded core laboratory. Multivariable logistic regression analysis was performed to assess the independent associations between LAHB on the admission ECG and in-hospital and 6-month mortality.

Results Of the 11 820 eligible ACS patients, 692 (5.9%) patients had LAHB. The presence of LAHB on admission was associated with older age, male sex, prior myocardial infarction, prior heart failure, worse Killip class, higher creatinine level, and higher GRACE risk score (all p<0.01). Patients with LAHB less frequently underwent cardiac catheterisation, coronary revascularisation or reperfusion therapy (all p<0.05). The LAHB group had higher in-hospital (6.9% vs 3.9%, p<0.001) and 6-month mortality (12.5% vs 7.7%, p<0.001). However, after adjusting for the known predictors of mortality in the GRACE risk models, LAHB was not independently associated with in-hospital death (OR 1.07, 95% CI 0.76 to 1.52, p=0.70), or death at 6 months (OR 1.00, 95% CI 0.75 to 1.34, p=0.99).

Conclusions Across the broad spectrum of ACS, LAHB was associated with significant comorbidities, high-risk clinical features on presentation, and worse unadjusted outcomes. However, LAHB was not an independent predictor of in-hospital and 6-month mortality and did not carry incremental prognostic value beyond the known prognosticators in the GRACE risk models.

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