Background: Chest pain is less likely in old age and evidence of Coronary Artery Disease (CAD) may be detected in the presence of a new or presumably new Left Bundle Branch Block (LBBB).

Objectives: This study aimed to assess the predictive role of new LBBB in diagnosis of CAD.

Patients and Methods: This prospective study was conducted on 402 patients with LBBB admitted to our institute between January 2011 and June 2013. Among the patients, only 272 had new or presumably new LBBB. The patients were divided into two groups (age ≤ 65 years and > 65 years) and all the demographic, clinical, and procedural characteristics were prospectively recorded. Statistical analyses were performed using the Statistical Package for Social Sciences (SPSS Inc.), version 17.0. Nominal variables were described using frequencies and normal distribution of quantitative variables was tested by means of Kolmogorov-Smirnov test. P < 0.05 was considered as statistically significant.

Results: Patients older than 65 years had less common chest pain, lower procedural use (76.47% vs. 84.56%, P = 0.001), longer duration of hospitalization, and higher rate of in-hospital mortality. Older patients also had either one or three coronary lesions (27.97%) compared to the younger ones 62.50% of whom had no vessel disease.

Conclusions: Presence of new or presumably new LBBB in elders, and even in those without the classic symptoms of chest pain, may be the first manifestation of CAD.