Electrocardiographic Diagnosis of Acute Coronary Occlusion Myocardial Infarction in Ventricular Paced Rhythm Using the Modified Sgarbossa Criteria

Dodd, Kenneth W.; Zvosec, Deborah L.; Hart, Michael H.; Glass, George; Bannister, Laura; Body, Richard; Boggust, Brett A.; Brady, William J.; Cullen, Louise; Gómez-Vicente, Rafael; Veld, Maite A. Huis in ‘t; Karim, Rehan; Meyers, H. Pendell; Miranda, David; Mitchell, Gary; Reynard, Charles; Rice, Clifford; Salverda, Bayert; Stellpflug, Samuel J.; Tolia, Vaishal; Walsh, Barbara C.; White, J. Chris; Smith, Stephen W.; Henry, Timothy D.; Zarich, Stuart; Aghamohammadzadeh, Reza; Martí, David; Aldous, Sally; Than, Martin; Wang, Ernest E.; Levisay, Justin; Nelson, W. Bradley; Lurie, Keith G.; Singer, Adam J.; Chang, Anna Marie; Oje, Adesola O.; Corbett-Detig, James; Wilkerson, R. Gentry; Taylor, Angela M.

doi:10.1016/j.annemergmed.2021.03.036

Cited by 30 publications

(16 citation statements)

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“…Ventricular paced rhythm may obscure Q waves and cause secondary repolarization abnormalities on the ECG [ 4 ]. These changes can prevent accurate recognition of AMI in the setting of cardiac pacing, resulting in suboptimal outcomes [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Electrocardiographic diagnosis of acute myocardial infarction in a pacemaker patient: a case report

Zhang

2022

BMC Cardiovasc Disord

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Background The electrocardiographic diagnosis of acute myocardial infarction (AMI) in the setting of cardiac pacing is often challenging. The original Sgarbossa criteria proposed in 1996 were demonstrated to be valid for diagnosis of AMI in both ventricular paced rhythm and left bundle branch block. To improve accuracy, the modified Sgarbossa criteria (MSC) were proposed. Case presentation We presented a case of electrocardiographic diagnosis of AMI in a pacemaker patient. The Electrocardiogram (ECG) was false negative by using the original Sgarbossa criteria, whereas true positive by the MSC at a ratio of − 0.20. Conclusions The application of MSC using an appropriate ratio (− 0.20 or − 0.25) may facilitate a timely diagnosis of AMI. Physicians should carefully choose the appropriate cutoff in a case-by-case basis.

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Section: Discussionmentioning

confidence: 99%

Electrocardiographic diagnosis of acute myocardial infarction in a pacemaker patient: a case report

Zhang

2022

BMC Cardiovasc Disord

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“… 27 Thus, ≈20% of true STEMIs have TIMI 3 flow at immediate angiogram. As such, the definition of OMI was reproduced from prior studies, 23 , 28 , 29 , 30 , 31 , 32 composed of either (1) “confirmed OMI” on cardiac catheterization (defined as an acute culprit lesion with TIMI 0–2 flow) or (2) “presumed OMI with significant cardiac outcome,” defined as any of the following: (a) acute but nonocclusive (TIMI >2) culprit lesion with highly elevated cardiac troponin (contemporary cardiac troponin T ≥1.0 ng/mL [Roche Diagnostics Elecsys; reference range, ≤0.01 ng/mL] or contemporary cardiac troponin I ≥10.0 ng/mL [Abbott Architect 4th generation; reference range, ≤0.030 ng/mL]); (b) if no angiography, then highly elevated cardiac troponin and a new or presumed new regional wall motion abnormality on echocardiography; or (c) ECG positive for STEMI with death before attempted emergent catheterization. Despite the fact that OMI cannot be based solely on TIMI 0 to 1 flow of the culprit lesion for the reasons explained above, we also presented TIMI 0 to 1 culprit lesions as a dedicated outcome.…”

Section: Methodsmentioning

confidence: 99%

“…The definition of “highly elevated” cardiac troponin was chosen previously as the most accurate cutoff for differentiating STEMIs from non–ST‐segment–elevation myocardial infarctions using various cardiac troponin assays, 33 , 34 , 35 , 36 , 37 and has subsequently been internally and externally validated. 23 , 28 , 30 , 32 , 38 , 39 …”

Section: Methodsmentioning

confidence: 99%

Ischemic ST‐Segment Depression Maximal in V1–V4 (Versus V5–V6) of Any Amplitude Is Specific for Occlusion Myocardial Infarction (Versus Nonocclusive Ischemia)

Meyers

Bracey

Lee

et al. 2021

JAHA

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Background Occlusion myocardial infarctions (OMIs) of the posterolateral walls are commonly missed by ST‐segment–elevation myocardial infarction (STEMI) criteria, with >50% of patients with circumflex occlusion not receiving emergent reperfusion and experiencing increased mortality. ST‐segment depression maximal in leads V1–V4 (STDmaxV1–4) has been suggested as an indicator of posterior OMI. Methods and Results We retrospectively reviewed a high‐risk population with acute coronary syndrome. OMI was defined from prior studies as a culprit lesion with TIMI (Thrombolysis in Myocardial Infarction) 0 to 2 flow or TIMI 3 flow plus peak troponin T >1.0 ng/mL or troponin I >10 ng/mL. STEMI was defined by the Fourth Universal Definition of Myocardial Infarction. ECGs were interpreted blinded to outcomes. Among 808 patients, there were 265 OMIs, 108 (41%) meeting STEMI criteria. A total of 118 (15%) patients had “suspected ischemic” STDmaxV1–4, of whom 106 (90%) had an acute culprit lesion, 99 (84%) had OMI, and 95 (81%) underwent percutaneous coronary intervention. Suspected ischemic STDmaxV1–4 had 97% specificity and 37% sensitivity for OMI. Of the 99 OMIs detected by STDmaxV1–4, 34% had <1 mm ST‐segment depression, and only 47 (47%) had accompanying STEMI criteria, of which 17 (36%) were identified a median 1.00 hour earlier by STDmaxV1–4 than STEMI criteria. Despite similar infarct size, TIMI flow, and coronary interventions, patients with STEMI(−) OMI and STDmaxV1–4 were less likely than STEMI(+) patients to undergo catheterization within 90 minutes (46% versus 68%; P =0.028). Conclusions Among patients with high‐risk acute coronary syndrome, the specificity of ischemic STDmaxV1–4 was 97% for OMI and 96% for OMI requiring emergent percutaneous coronary intervention. STEMI criteria missed half of OMIs detected by STDmaxV1–4. Ischemic STDmaxV1–V4 in acute coronary syndrome should be considered OMI until proven otherwise.

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“…2 A recent multicentre retrospective study showed that the SMSC are far more sensitive than the OSC for the diagnosis of AMI in the presence of RVPR (sensitivity of 81% vs 56%) while maintaining high specificities (84% vs 90%). 3 The sensitivity of the SMSC is even higher if criterion 2 from the OSC is extended out to V1-V6 (instead of only V1-V3). 3 These findings dispel the notion that it is not possible to diagnose AMI in patients with RVPR and LBBB, many of whom would be candidates for timely reperfusion therapy.…”

Section: Images In…mentioning

confidence: 99%

“…3 The sensitivity of the SMSC is even higher if criterion 2 from the OSC is extended out to V1-V6 (instead of only V1-V3). 3 These findings dispel the notion that it is not possible to diagnose AMI in patients with RVPR and LBBB, many of whom would be candidates for timely reperfusion therapy.…”

Section: Images In…mentioning

confidence: 99%

Diagnosing STEMI in the presence of paced rhythm: dispelling the myth of the ‘uninterpretable paced ECG’

Vrettos

Panoulas

2021

BMJ Case Rep

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Electrocardiographic Diagnosis of Acute Coronary Occlusion Myocardial Infarction in Ventricular Paced Rhythm Using the Modified Sgarbossa Criteria

Cited by 30 publications

References 50 publications

Electrocardiographic diagnosis of acute myocardial infarction in a pacemaker patient: a case report

Electrocardiographic diagnosis of acute myocardial infarction in a pacemaker patient: a case report

Ischemic ST‐Segment Depression Maximal in V1–V4 (Versus V5–V6) of Any Amplitude Is Specific for Occlusion Myocardial Infarction (Versus Nonocclusive Ischemia)

Diagnosing STEMI in the presence of paced rhythm: dispelling the myth of the ‘uninterpretable paced ECG’

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