Diagnosing Acute Myocardial Infarction in Patients With Left Bundle Branch Block

Lopes, Renato D.; Siha, Hany; Fu, Yuling; Mehta, Rajendra H.; Patel, Manesh R.; Armstrong, Paul W.; Granger, Christopher B.

doi:10.1016/j.amjcard.2011.05.006

Cited by 48 publications

(35 citation statements)

References 15 publications

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“…However, 44.1% of patients without concordant ST elevation also had elevated cardiac markers with an initially occluded infarct artery, leading Lopes et al to conclude that pPCI should be offered to all patients with suspected STEMI and nLBBB. 21 Further, it's been postulated that the Sgarbossa criteria are more likely to be met in patients with a larger AMI. 8,10 However, none of our 3 patients with concordant ST elevation ≥1 mm had CK-MB levels ≥2 times the upper limit of the normal range.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of acute myocardial infarction in patients with presumably new left bundle-branch block

Mehta

Huang

Bandeali

et al. 2012

Journal of Electrocardiology

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Section: Discussionmentioning

confidence: 99%

Prevalence of acute myocardial infarction in patients with presumably new left bundle-branch block

Mehta

Huang

Bandeali

et al. 2012

Journal of Electrocardiology

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“…These ECG criteria 15 have shown varying potential for identifying patients with left BBB and AMI with relevant coronary lesions. In one study by Lopes et al, 16 comprising AMI patients from a multicentre AMI trial, the Sgarbossa criteria of concordant ST-elevation were more often associated with AMI and an initially occluded infarctrelated artery. Another recent study by Jain et al 9 in a population of patients with suspected myocardial infarction and left BBB found a very low sensitivity of the Sgarbossa criteria for correct identification of new-onset left BBBMI, although there was a very high positive predictive value.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and outcome in a prehospital cohort of patients with bundle branch block and suspected acute myocardial infarction

Sørensen

Stengaard

Sørensen

et al. 2013

European Heart Journal: Acute Cardiovascular Care

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Background: Immediate revascularization is beneficial in patients with presumed new-onset bundle branch block myocardial infarction (BBBMI). In the prehospital setting, it is a challenge to diagnose new-onset BBBMI and triage accordingly. Methods: ECG, final diagnosis, and mortality were assessed in a prehospital cohort of 4905 consecutive patients with suspected acute myocardial infarction (AMI). Bundle branch block (BBB) was defined as QRS duration ≥120 ms caused by delayed intraventricular conduction. Mortality and angiography data were obtained from the Central Office of Civil Registration and the Western Denmark Heart Registry. Definite diagnosis of AMI and the onset of BBB were determined by expert consensus. Patients were divided into four groups: with or without AMI and with or without BBB. Mortality was evaluated by Kaplan-Meier plots and compared using log-rank statistics. Results: AMI was diagnosed in 954 patients, of whom 118 had BBB. In 3951 patients without AMI, 436 had BBB. Patients with BBBMI were less often revascularized than patients with AMI without BBB (24 vs. 54%, p<0.001). BBBMI was categorized as new onset in 43 patients of whom two were triaged for acute angioplasty. One-year mortality was 47.2, 17.5, 20.8, and 8.6% (log-rank <0.001) in patients with BBBMI, patients with AMI without BBB, patients with BBB without AMI, and patients without AMI or BBB, respectively. Conclusions: Patients with BBBMI have a high mortality. Less than 25% undergo revascularization and only very few patients with new-onset BBBMI are transferred for urgent revascularization. Focus on improving triage and prehospital identification of high-risk patients with BBB and chest pain could improve outcome.

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“…In patients with pre-existing LBBB, concordant ST-elevations may be the best indicator of ongoing acute MI [9], while more complex algorithms do not seem to provide sufficient diagnostic certainty [10]. When standard leads are inconclusive in patients with suspected [4], used with permission of Oxford University Press).…”

Section: Ecg Cardiac Troponin and Cardiac Imaging In Acute MI The Elmentioning

confidence: 99%

State-of-the-art diagnosis of myocardial infarction

Vafaie

2016

Diagnosis

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Abstract:The current version of the Universal Definition of Myocardial Infarction (MI) was published in 2012. An acute myocardial infarction (AMI) is characterized by evidence of myocardial necrosis in a clinical setting of acute myocardial ischemia. Diagnostic criteria include a rise and/or fall of serially tested cardiac biomarkers (preferentially cardiac troponins) with at least one value above the 99th percentile of the upper reference limit combined with symptoms of ischemia, new changes on electrocardiogram (ECG), imaging evidence of a new loss of viable myocardium or new regional wall motion abnormalities or the identification of an intracoronary thrombus by angiography or autopsy. Compared to previous versions, the current definition of MI includes minor modifications regarding ECG criteria and subtypes of MI as well as the use of cardiac imaging and high sensitivity troponin assays. This article summarizes the Universal MI definition and includes recommendations from the current guidelines for the management of patients with acute coronary syndrome. Strategies for "early rule-in" and "rule-out" of non-ST-elevation MI with high sensitivity cardiac troponin assays, risk scores for assessment of ischemic and bleeding risk and criteria for optimal timing of angiography are presented.

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Diagnosing Acute Myocardial Infarction in Patients With Left Bundle Branch Block

Cited by 48 publications

References 15 publications

Prevalence of acute myocardial infarction in patients with presumably new left bundle-branch block

Prevalence of acute myocardial infarction in patients with presumably new left bundle-branch block

Diagnosis and outcome in a prehospital cohort of patients with bundle branch block and suspected acute myocardial infarction

State-of-the-art diagnosis of myocardial infarction

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