Unraveling the spectrum of left bundle branch block in acute myocardial infarction: insights from the Assessment of the Safety and Efficacy of a New Thrombolytic (ASSENT 2 and 3) trials
2006 (English)In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 151, no 1, 10-5 p.Article in journal (Refereed) Published
BACKGROUND: Left bundle branch block (LBBB) complicates the diagnosis of acute myocardial infarction (AMI). The Sgarbossa criteria were developed from GUSTO I to surmount this diagnostic challenge but have not been prospectively validated in a large population with presumed AMI. We evaluated their utility in the diagnosis and risk stratification of AMI patients in ASSENT 2 & 3. METHODS: Baseline electrocardiograms (ECG) of LBBB patients were scored using Sgarbossa's criteria (0-10) by 2 readers blinded to the CK/CK-MB data and clinical outcomes; 267 (1.2%) patients had LBBB on their baseline ECG. RESULTS: Among 253 LBBB patients with available peak CK/CK-MB data, 158 (62.5%) had peak CK/CK-MB levels > 2x ULN, thereby qualifying for the diagnosis of AMI. A Sgarbossa score of 3 was shown in 48.7% of LBBB patients with elevated CK/CK-MB versus in 12.6% of those without a CK/CK-MB rise (P < .001). Patients with higher Sgarbossa scores, ie, 3, had a higher mortality compared with those with a score < 3, (23.5% vs 7.7% at 30 days P < .001; and 33.7% vs 20.2% at 1 year, P < .001, respectively). CONCLUSIONS: Our findings validate the utility of Sgarbossa criteria for diagnosing AMI in the setting of LBBB. These criteria provide a simple and practical diagnostic approach to risk stratify this diagnostically challenging high-risk group and optimize risk-benefit of acute therapy.
Place, publisher, year, edition, pages
2006. Vol. 151, no 1, 10-5 p.
Aged, Bundle-Branch Block/*complications, Clinical Trials, Electrocardiography/methods, Female, Humans, Male, Middle Aged, Myocardial Infarction/*complications/*diagnosis, Prognosis, Risk Assessment
Medical and Health Sciences
IdentifiersURN: urn:nbn:se:uu:diva-24435DOI: 10.1016/j.ahj.2005.02.043PubMedID: 16368285OAI: oai:DiVA.org:uu-24435DiVA: diva2:52209