Author + information
- Supreeti Behuria,
- Joseph C. Yu,
- Rajbir Sidhu,
- Perry Fisher,
- Deepika Misra,
- Paul (Pavol) Schweitzer and
- Yumiko Kanei
Background: Accurate recognition of ST elevation myocardial infarction (STEMI) in the presence of left bundle branch block (LBBB) remains a challenge. Sgarbossa criteria has a sensitivity of 52% and a specificity of 98%, while modified Sgarbossa criteria has a sensitivity of 91% and specificity of 90% for diagnosing acute myocardial infarction (AMI). The most recent STEMI guidelines no longer include new LBBB as an indication for emergent reperfusion. The aim of our study was to review the clinical, electrocardiographic and angiographic findings of patients presenting with cardiac complaints and new LBBB.
Methods: Adults presenting to our emergency center between 1/1/2011 and 1/1/2014 were screened for the presence of a LBBB. Those with cardiac complaints were included while those with pre-existing LBBB were excluded. The electrocardiograms (ECGs) were analyzed according to the Sgarbossa and Modified Sgarbossa criteria. Cardiac testing including echocardiogram and coronary angiography was reviewed to discern the presence of coronary artery disease.
Results: There were 1098 patient-visits for 648 patients with an initial ECG showing a LBBB; 298 (46%) presented with cardiac complaints. Among these, 180 patients had new or previously undiagnosed LBBB. Sixty four (36%) patients presented with chest pain and 5 (3%) presented after a cardiac arrest. The diagnosis of AMI was made in 3 (2%) patients resulting in emergent percutaneous coronary interventions. Among them, one patient met Sgarbossa and Modified Sgarbossa criteria. The sensitivity of Sgarbossa criteria in our study was 33%, and specificity was 98%. 33 (18%) patients underwent non-emergent coronary angiograms, and 12 patients (7%) had significant coronary artery disease.
Conclusions: Among 180 patients who presented with cardiac complaints and a new LBBB, the incidence of AMI was rare, with one patient fulfilling Sgarbossa and modified Sgarbossa criteria. New LBBB as a STEMI equivalent is rare with low and varying diagnostic sensitivities for both the Sgarbossa and modified Sgarbossa criteria. AMI should not be considered solely based on new LBBB unless the clinical presentation and additional diagnostic assessments are in agreement.
Poster Contributions Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Timely Topics in Acute Coronary Syndromes
Abstract Category: 15. Interventional Cardiology: ACS/AMI/Hemodynamics and Pharmacology Presentation Number: 1242-153
- 2017 American College of Cardiology Foundation