Key result
BARCELONA algorithm outperforms previous rules for diagnosing AMI in LBBB with ~94% sensitivity.
Why the study?
Current electrocardiographic algorithms lack sensitivity to diagnose acute myocardial infarction in the presence of left bundle branch block.
Does the BARCELONA electrocardiographic algorithm improve diagnostic accuracy for acute myocardial infarction compared to previous rules in patients with left bundle branch block?
Cohort (n=484)
Yes
Does the BARCELONA electrocardiographic algorithm improve diagnostic accuracy for acute myocardial infarction compared to previous rules in patients with left bundle branch block?
p-value: p=<0.01
The BARCELONA algorithm provides high sensitivity and specificity for diagnosing acute myocardial infarction in patients with left bundle branch block, outperforming previous electrocardiographic criteria.
May support BARCELONA algorithm adoption for AMI in LBBB; leaves open prospective validation before practice change.
Background Current electrocardiographic algorithms lack sensitivity to diagnose acute myocardial infarction ( AMI ) in the presence of left bundle branch block. Methods and Results A multicenter retrospective cohort study including consecutive patients with suspected AMI and left bundle branch block, referred for primary percutaneous coronary intervention between 2009 and 2018. Pre‐2015 patients formed the derivation cohort (n=163, 61 with AMI ); patients between 2015 and 2018 formed the validation cohort (n=107, 40 with AMI ). A control group of patients without suspected AMI was also studied (n=214). Different electrocardiographic criteria were tested. A total of 484 patients were studied. A new electrocardiographic algorithm ( BARCELONA algorithm) was derived and validated. The algorithm is positive in the presence of ST deviation ≥1 mm (0.1 mV) concordant with QRS polarity, in any lead, or ST deviation ≥1 mm (0.1 mV) discordant with the QRS , in leads with max (R|S) voltage (the voltage of the largest deflection of the QRS , ie, R or S wave) ≤6 mm (0.6 mV). In both the derivation and the validation cohort, the BARCELONA algorithm achieved the highest sensitivity (93%–95%), negative predictive value (96%–97%), efficiency (91%–94%) and area under the receiver operating characteristic curve (0.92–0.93), significantly higher than previous electrocardiographic rules ( P <0.01); the specificity was good in both groups (89%–94%) as well as the control group (90%). Conclusions In patients with left bundle branch block referred for primary percutaneous coronary intervention , the BARCELONA algorithm was specific and highly sensitive for the diagnosis of AMI , leading to a diagnostic accuracy comparable to that obtained by ECG in patients without left bundle branch block.
No takes yet. Share an insight, caveat, or question.
Marco et al. (2020) conducted a cohort in Suspected acute myocardial infarction with left bundle branch block (n=484). BARCELONA algorithm vs. Previous electrocardiographic rules was evaluated on Sensitivity, negative predictive value, efficiency, and area under the receiver operating characteristic curve for the diagnosis of AMI (p=<0.01). The BARCELONA algorithm achieved high sensitivity (93%-95%) and diagnostic accuracy (AUC 0.92-0.93) for diagnosing AMI in patients with left bundle branch block, outperforming previous rules (P<0.01).