Abstract
Background
The Sgarbossa score has been used to identify acute myocardial infarction on ECG in
the presence of LBBB but has relied on elevated CK-MB for validation rather than angiographic
evidence of vessel occlusion.
Methods
We determined (a) the presence or absence of Sgarbossa criteria with concordant (S-con)
or discordant (S-dis) ST changes, (b) the presence of acute coronary occlusion or
likely recent occlusion on angiography and (c) the biochemical evidence of myocardial
infarction (Troponin T >0.10 μg/L, Troponin I >1.0 μg/L) in patients field-triaged with suspected AMI and LBBB.
Results
Between April 2004 and March 2009, 102 patients had field ECGs transmitted by paramedics
for triage — 8 with S-con, 26 with S-dis and 68 with LBBB alone. Acute coronary occlusion
was present in 8/8 with S-con but none of the S-dis or LBBB alone patients, and in
all 8 S-con patients reperfusion resulted in resolution of S-con changes. Likely culprit
lesions with TIMI 3 flow were found in 3 S-dis patients but stenting did not result
in resolution of S-dis. LBBB did not resolve in any patient. Troponin was elevated
in 26 patients — 11 with occlusion or likely culprit lesions, 15 with non-ischaemic
causes.
Conclusions
In the absence of S-con, LBBB is not associated with acute coronary occlusion and
should not be used as criteria for reperfusion therapy in myocardial infarction.
Keywords
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Article info
Publication history
Published online: May 01, 2012
Accepted:
April 1,
2012
Received:
March 22,
2012
Identification
Copyright
© 2012 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
