New Electrocardiographic Algorithm for the Diagnosis of Acute Myocardial Infarction in Patients With Left Bundle Branch Block
Por:
Di Marco, A, Rodriguez, M, Cinca, J, Bayes-Genis, A, Ortiz-Perez, JT, Ariza-Sole, A, Sanchez-Salado, JC, Sionis, A, Rodriguez, J, Toledano, B, Codina, P, Sole-Gonzalez, E, Masotti, M, Gomez-Hospital, JA, Cequier, A, Anguera, I
Publicada:
21 jul 2020
Resumen:
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.
Filiaciones:
Di Marco, A:
Bellvitge Univ Hosp, Heart Dis Inst, Barcelona, Spain
Rodriguez, M:
Bellvitge Univ Hosp, Heart Dis Inst, Barcelona, Spain
Cinca, J:
Univ Autonoma Barcelona, CIBERCV, IIB Santpau, Cardiol Dept,Hosp Santa Creu & St Pau, Barcelona, Spain
Bayes-Genis, A:
Germans Trias & Pujol Univ Hosp, Cardiol Dept, Barcelona, Spain
Ortiz-Perez, JT:
Hosp Clin Barcelona, Cardiol Dept, CIBERCV, Barcelona, Spain
Ariza-Sole, A:
Bellvitge Univ Hosp, Heart Dis Inst, Barcelona, Spain
Sanchez-Salado, JC:
Bellvitge Univ Hosp, Heart Dis Inst, Barcelona, Spain
Sionis, A:
Univ Autonoma Barcelona, CIBERCV, IIB Santpau, Cardiol Dept,Hosp Santa Creu & St Pau, Barcelona, Spain
Rodriguez, J:
Hosp Clin Barcelona, Cardiol Dept, CIBERCV, Barcelona, Spain
Toledano, B:
Germans Trias & Pujol Univ Hosp, Cardiol Dept, Barcelona, Spain
Codina, P:
Germans Trias & Pujol Univ Hosp, Cardiol Dept, Barcelona, Spain
Sole-Gonzalez, E:
Univ Autonoma Barcelona, CIBERCV, IIB Santpau, Cardiol Dept,Hosp Santa Creu & St Pau, Barcelona, Spain
Masotti, M:
Hosp Clin Barcelona, Cardiol Dept, CIBERCV, Barcelona, Spain
Gomez-Hospital, JA:
Bellvitge Univ Hosp, Heart Dis Inst, Barcelona, Spain
Cequier, A:
Bellvitge Univ Hosp, Heart Dis Inst, Barcelona, Spain
Anguera, I:
Bellvitge Univ Hosp, Heart Dis Inst, Barcelona, Spain
Gold, Green Published
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