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.
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.
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.
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.
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- Left bundle branch block: a continuously evolving concept.J Am Coll Cardiol. 1987; 9: 684-697
- Clinical and anatomic implications of intraventricular conduction blocks in acute myocardial infarction.Circulation. 1972; 66: 753-760
- Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block.N Engl J Med. 1996; 334: 481-487
- Unravelling the spectrum of left bundle branch block in acute myocardial infarction: insights from the assessment of the safety and efficacy of a new thrombolytic (ASSENT 2 and 3) trials.Am Heart J. 2006; 151: 10-15
- Suspected myocardial infarction and left bundle branch block: electrocardiographic indicators of acute ischemia.J Accid Emerg Med. 1999; 16: 331-335
- Can myocardial infarction be rapidly identified in emergency department patients who have left bundle branch block?.Ann Emerg Med. 2001; 37: 431-438
- Electrocardiographic diagnosis of myocardial infarction in patients with left bundle branch block.Ann Emerg Med. 2000; 36: 561-565
- Field triage to primary angioplasty combined with emergency department bypass reduces treatment delays and is associated with improved outcome.Eur Heart J. 2007; 28: 2313-2319
- Direct ambulance admission to the cardiac catheterisation laboratory significantly reduces door-to-balloon times in primary percutaneous coronary intervention.Am Heart J. 2008; 155: 1054-1058
- The significance of bundle branch block during acute myocardial infarction.Am Heart J. 1975; 90: 439-444
- Bundle branch block in patients with chronic coronary artery disease: angiographic correlates and prognostic significance.J Am Coll Cardiol. 1987; 10: 73-80
- Coronary artery disease and major conduction disturbances.Am Heart J. 1969; 77: 411-422
- Prevalence of coronary occlusion and outcome of an immediate invasive strategy in suspected acute myocardial infarction with and without ST-segment elevation.Am J Cardiol. 2002; 90: 579-584
Published online: May 01, 2012
Accepted: April 1, 2012
Received: March 22, 2012
© 2012 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.