Diagnosis of ST-Elevation Myocardial Infarction in the Presence of Left Bundle Branch Block With the ST-Elevation to S-Wave Ratio in a Modified Sgarbossa Rule

2012 ◽  
Vol 60 (6) ◽  
pp. 766-776 ◽  
Author(s):  
Stephen W. Smith ◽  
Kenneth W. Dodd ◽  
Timothy D. Henry ◽  
David M. Dvorak ◽  
Lesly A. Pearce
Keyword(s):  
Myocardial Infarction ◽  
Left Bundle Branch Block ◽  
St Elevation Myocardial Infarction ◽  
S Wave ◽  
Bundle Branch Block ◽  
St Elevation

scholarly journals New or presumed new left bundle branch block in patients with suspected ST-elevation myocardial infarction

2017 ◽  
Vol 7 (3) ◽  
pp. 208-217 ◽  
Author(s):  
Vijaya K Pera ◽  
David M Larson ◽  
Scott W Sharkey ◽  
Ross F Garberich ◽  
Christopher J Solie ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Left Bundle Branch Block ◽  
New Left ◽  
High Sensitivity ◽  
Reperfusion Therapy ◽  
St Elevation Myocardial Infarction ◽  
High Risk Population ◽  
Culprit Lesion ◽  
Bundle Branch Block ◽  
St Elevation

Aims: Using a comprehensive large prospective regional ST-elevation myocardial infarction (STEMI) system database, we evaluated the prevalence, clinical and angiographic characteristics, and outcomes in patients with ischemic symptoms and new or presumed new left bundle branch block (LBBB). We then tested a new hierarchical diagnosis and triage algorithm to identify more accurately new LBBB patients with an acute culprit lesion. Methods and results: From March 2003 to June 2013, 3903 consecutive STEMI patients were treated using the Minneapolis Heart Institute regional STEMI protocol including 131 patients (3.3%) with new LBBB. These patients had fewer culprit arteries (54.2% vs. 86.4%; P<0.001), were older, more commonly women, with a lower ejection fraction, and more frequently presented with cardiac arrest or heart failure than those without new LBBB. At 1 year follow-up, all-cause mortality accounting for baseline differences was higher in patients with new LBBB (hazard ratio 1.73, 95% confidence interval 1.17–2.58; P=0.007). The new algorithm yielded high sensitivity (97%) and negative predictive value (94%) for identification of a culprit lesion. Using the definition of new LBBB with either hemodynamically unstable features or Sgarbossa concordance criteria on electrocardiogram (ECG), 45% of new LBBB patients would have been treated as ‘STEMI equivalent’. Conclusion: Patients with acute ischemic symptoms and new LBBB represent a high-risk population with unique clinical challenges. If validated in an independent dataset, the new algorithm may improve the diagnostic accuracy regarding reperfusion therapy for new LBBB patients.

Sign in / Sign up

Export Citation Format

Share Document