Key result
Modified Sgarbossa criteria yields ~60% sensitivity for occlusion MI in LBBB despite low positive predictive values.
Why the study?
ECG detection of occlusion myocardial infarction in patients with LBBB or ventricular paced rhythm is difficult, and the recently proposed Barcelona criteria had not been externally validated.
Do current ECG criteria accurately detect occlusion myocardial infarction in emergency department patients presenting with chest pain and LBBB or ventricular paced rhythm?
Observational (n=623)
Yes
Do current ECG criteria accurately detect occlusion myocardial infarction in emergency department patients presenting with chest pain and LBBB or ventricular paced rhythm?
Current ECG criteria, including Sgarbossa, modified Sgarbossa, Barcelona, and Selvester, have low sensitivity and poor positive predictive value for detecting occlusion myocardial infarction in ED patients with LBBB or ventricular pacing, suggesting they are insufficient as standalone diagnostic tools.
Answers are grounded in this paper and cite their sources.
ECG criteria lack sufficient accuracy for OMI detection in LBBB or paced rhythms; leaves open need for better tools or multimodal strategies.
BACKGROUND: Electrocardiographic detection of patients with occlusion myocardial infarction (OMI) can be difficult in patients with left bundle branch block (LBBB) or ventricular paced rhythm (VPR) and several ECG criteria for the detection of OMI in LBBB/VPR exist. Most recently, the Barcelona criteria, which includes concordant ST deviation and discordant ST deviation in leads with low R/S amplitudes, showed superior diagnostic accuracy but has not been validated externally. We aimed to describe the diagnostic accuracy of four available ECG criteria for OMI detection in patients with LBBB/VPR at the emergency department. METHODS: The unweighted Sgarbossa criteria, the modified Sgarbossa criteria (MSC), the Barcelona criteria and the Selvester criteria were applied to chest pain patients with LBBB or VPR in a prospectively acquired database from five emergency departments. RESULTS: In total, 623 patients were included, among which 441 (71%) had LBBB and 182 (29%) had VPR. Among these, 82 (13%) patients were diagnosed with AMI, and an OMI was identified in 15 (2.4%) cases. Sensitivity/specificity of the original unweighted Sgarbossa criteria were 26.7/86.2%, for MSC 60.0/86.0%, for Barcelona criteria 53.3/82.2%, and for Selvester criteria 46.7/88.3%. In this setting with low prevalence of OMI, positive predictive values were low (Sgarbossa: 4.6%; MSC: 9.4%; Barcelona criteria: 6.9%; Selvester criteria: 9.0%) and negative predictive values were high (all >98.0%). CONCLUSIONS: Our results suggests that ECG criteria alone are insufficient in predicting presence of OMI in an ED setting with low prevalence of OMI, and the search for better rapid diagnostic instruments in this setting should continue.
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Lindow et al. (2023) conducted an observational in Chest pain with left bundle branch block or ventricular paced rhythm (n=623). ECG criteria (unweighted Sgarbossa, modified Sgarbossa, Barcelona, Selvester) was evaluated on Diagnostic accuracy (sensitivity, specificity, predictive values) for occlusion myocardial infarction. In ED patients with LBBB or paced rhythm, the modified Sgarbossa criteria had the highest sensitivity (60.0%) for occlusion MI, but all four ECG criteria had low positive predictive values (<10%).
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