THE IMPoRTAnCE of ExPAnDED SGARBoSSA CRITERIA foR DIAGnoSIS of ACUTE CoRonARY SYnDRoMES In PATIEnTS wITH lEfT BUnDlE BRAnCH BloCK: A CASE SERIES

SUMMARY The occurrence of left bundle branch block (LBBB) significantly deforms the processes of depolarization and repolarization, which decreases the sensitivity of the electrocardiogram (EKG) as a diagnostic method in patients with acute ischemia. The presence of expanded Sgarbossa criteria increases the sensitivity and specificity of the ECG. Aim: The objective of this study was to examine the connection of expanded Sgarbossa criteria with acute coronary syndrome (ACS) in patients with LBBB and the intrahospital mortality of these patients with all certain risk factors. Methodology of the study: This study included 340 patients hospitalized in the coronary unit of the KC Kragujevac Cardiology Center from 1 January 2008 to 10 January 2008. During this period, 20 patients were diagnosed with left bundle branch block. Patients with LBBB were divided into two sub-groups according to the ranges of cardio-specific enzymes: 14 (70%) had a laboratory confirmed diagnosis of ACS, and 6 (30%) patients did not have a confirmed ACS diagnosis. In this study we observed the presence of the following risk factors: hypertension (HTA), heritage, diabetes mellitus (DM), smoking, hyperlipoproteinemia (HLP), and a previous attack of ischemic heart disease (IHD). Besides the risk factors mentioned above, we observed heart rate, the values of systolic and diastolic blood pressure on admission, the presence of expanded Sgarbossa criteria, the use of medications, and intrahospital mortality. Statistical analysis was performed by Fisher’s test or a Student’s T-test where appropriate. Results: We showed that the expanded Sgarbossa criteria should not be neglected when establishing a diagnosis of acute coronary syndrome. The following criteria were particularly important: positive T wave in leads V 5 or V 6 , a sign of Cabrera ascending limb of the S wave in V 3 or V 4 , the presence of an S wave in lead V 5 or V 6 , the presence of a Q wave in two contiguous precordial leads, and left-axis deviation. We also showed that diabetes mellitus (DM) was the only risk factor linked with ACS with LBBB (p = 0.018) because it increased the likelihood of the occurrence of ACS with LBBB (odds ratio SOR¹ = 42; 95% CI 1.176-1497.973; p < 0.05) by 42 times and had a statistically significant influence on the occurrence of ACS with LBBB (p = 0.04). We observed that intrahospital mortality was higher if ACS was accompanied by LBBB even though Fisher’s test showed no dependency between mortality and patients with ACS and LBBB (p = 1.00).