Unraveling 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

Left bundle branch block (LBBB) complicates the diagnosis of acute myocardial infarction (AMI). The Sgarbossa criteria were developed from GUSTO I to surmount this diagnostic challenge but have not been prospectively validated in a large population with presumed AMI. We evaluated their utility in th...

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Bibliographic Details
Published in:The American heart journal 2006, Vol.151 (1), p.10-15
Main Authors: Al-Faleh, Hussam, Fu, Yuling, Wagner, Galen, Goodman, Shaun, Sgarbossa, Elena, Granger, Christopher, Van de Werf, Frans, Wallentin, Lars, W. Armstrong, Paul
Format: Article
Language:English
Subjects:
Aged
Bundle-Branch Block - complications
Clinical Trials
Clinical Trials as Topic
Coronary vessels
Diabetes
Electrocardiography
Electrocardiography - methods
Enzymes
Female
Heart attacks
Heart failure
Hospitalization
Humans
Ischemia
Kinases
Male
Medical prognosis
MEDICIN
MEDICINE
Middle Aged
Mortality
Myocardial Infarction - complications
Myocardial Infarction - diagnosis
Myocardial Infarction/complications/diagnosis
Prognosis
Risk Assessment
Statistical methods
Variables
Veins & arteries
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Summary:Left bundle branch block (LBBB) complicates the diagnosis of acute myocardial infarction (AMI). The Sgarbossa criteria were developed from GUSTO I to surmount this diagnostic challenge but have not been prospectively validated in a large population with presumed AMI. We evaluated their utility in the diagnosis and risk stratification of AMI patients in ASSENT 2 & 3. Baseline electrocardiograms (ECG) of LBBB patients were scored using Sgarbossa's criteria (0-10) by 2 readers blinded to the CK/CK-MB data and clinical outcomes; 267 (1.2%) patients had LBBB on their baseline ECG. Among 253 LBBB patients with available peak CK/CK-MB data, 158 (62.5%) had peak CK/CK-MB levels >2× ULN, thereby qualifying for the diagnosis of AMI. A Sgarbossa score of 3 was shown in 48.7% of LBBB patients with elevated CK/CK-MB versus in 12.6% of those without a CK/CK-MB rise ( P < .001). Patients with higher Sgarbossa scores, ie, 3, had a higher mortality compared with those with a score
ISSN:0002-8703
1097-6744
1097-6744
DOI:10.1016/j.ahj.2005.02.043