New Electrocardiographic Algorithm for the Diagnosis of Acute Myocardial Infarction in Patients With Left Bundle Branch Block
Di Marco, Andrea (Hospital Universitari de Bellvitge)
Rodriguez, Marcos (Hospital Universitari de Bellvitge)
Cinca, Juan (Institut d'Investigació Biomèdica Sant Pau)
Bayés-Genís, Antoni (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Ortiz-Perez, Jose T. (Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares)
Ariza-Solé, Albert (Hospital Universitari de Bellvitge)
Sanchez-Salado, Jose Carlos (Hospital Universitari de Bellvitge)
Sionis, Alessandro (Institut d'Investigació Biomèdica Sant Pau)
Rodriguez, Jany (Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares)
Toledano, Beatriz (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Codina, Pau (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Solé González, Eduard (Institut d'Investigació Biomèdica Sant Pau)
Masotti, Monica (Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares)
Gómez-Hospital, Joan Antoni (Hospital Universitari de Bellvitge)
Cequier, Ángel (Hospital Universitari de Bellvitge)
Anguera, Ignasi (Hospital Universitari de Bellvitge)
Universitat Autònoma de Barcelona

Date:	2020
Abstract:	Current electrocardiographic algorithms lack sensitivity to diagnose acute myocardial infarction () in the presence of left bundle branch block. A multicenter retrospective cohort study including consecutive patients with suspected and left bundle branch block, referred for primary percutaneous coronary intervention between 2009 and 2018. Pre-2015 patients formed the derivation cohort (n=163, 61 with ); patients between 2015 and 2018 formed the validation cohort (n=107, 40 with ). A control group of patients without suspected was also studied (n=214). Different electrocardiographic criteria were tested. A total of 484 patients were studied. A new electrocardiographic algorithm ( algorithm) was derived and validated. The algorithm is positive in the presence of deviation ≥1 mm (0. 1 mV) concordant with polarity, in any lead, or deviation ≥1 mm (0. 1 mV) discordant with the , in leads with max (R $s ) voltage (the voltage of the largest deflection of the , ie, R or S wave) ≤6 mm (0. 6 mV). In both the derivation and the validation cohort, the algorithm 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%). In patients with left bundle branch block referred for , the algorithm was specific and highly sensitive for the diagnosis of , leading to a diagnostic accuracy comparable to that obtained by in patients without left bundle branch block.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Acute myocardial infarction ; Electrocardiography ; Left bundle branch block ; Primary percutaneous coronary intervention ; Electrocardiology (ECG) ; Acute Coronary Syndromes
Published in:	Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol. 9 (july 2020) , ISSN 2047-9980

DOI: 10.1161/JAHA.119.015573
PMID: 32627643

22 p, 2.5 MB

The record appears in these collections:
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
Articles > Published articles