New Electrocardiographic Algorithm for the Diagnosis of Acute Myocardial Infarction in Patients With Left Bundle Branch Block
Background Current electrocardiographic algorithms lack sensitivity to diagnose acute myocardial infarction (AMI) in the presence of left bundle branch block. Methods and Results A multicenter retrospective cohort study including consecutive patients with suspectedAMIand left bundle branch block, re...
| Autores: | , , , , , , , , , , , , , , , |
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| Tipo de recurso: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2020 |
| País: | España |
| Institución: | Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau) |
| Repositorio: | r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau |
| OAI Identifier: | oai:iibsantpau.fundanetsuite.com:p1775 |
| Acceso en línea: | https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=1775 https://ddd.uab.cat/record/252730 |
| Access Level: | acceso abierto |
| Palabra clave: | acute myocardial infarction electrocardiography left bundle branch block primary percutaneous coronary intervention |
| Sumario: | Background Current electrocardiographic algorithms lack sensitivity to diagnose acute myocardial infarction (AMI) in the presence of left bundle branch block. Methods and Results A multicenter retrospective cohort study including consecutive patients with suspectedAMIand left bundle branch block, referred for primary percutaneous coronary intervention between 2009 and 2018. Pre-2015 patients formed the derivation cohort (n=163, 61 withAMI); patients between 2015 and 2018 formed the validation cohort (n=107, 40 withAMI). A control group of patients without suspectedAMIwas also studied (n=214). Different electrocardiographic criteria were tested. A total of 484 patients were studied. A new electrocardiographic algorithm (BARCELONAalgorithm) was derived and validated. The algorithm is positive in the presence ofSTdeviation >= 1 mm (0.1 mV) concordant withQRSpolarity, in any lead, orSTdeviation >= 1 mm (0.1 mV) discordant with theQRS, in leads with max (R|S) voltage (the voltage of the largest deflection of theQRS, ie, R or S wave) <= 6 mm (0.6 mV). In both the derivation and the validation cohort, theBARCELONAalgorithm achieved the highest sensitivity (93%-95%), negative predictive value (96%-97%), efficiency (91%-94%) and area under the receiver operating characteristic curve (0.92-0.93), significantly higher than previous electrocardiographic rules (P<0.01); the specificity was good in both groups (89%-94%) as well as the control group (90%). Conclusions In patients with left bundle branch block referred forprimary percutaneous coronary intervention, theBARCELONAalgorithm was specific and highly sensitive for the diagnosis ofAMI, leading to a diagnostic accuracy comparable to that obtained byECGin patients without left bundle branch block. |
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