EBQ:Sgarbossa Criteria Study: Difference between revisions
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==Clinical Question== | ==Clinical Question== | ||
How can we | How can we diagnose [[Acute Myocardial Infarction]] in patients with a [[Left Bundle Branch Block]]? | ||
==Conclusion== | ==Conclusion== | ||
[[Sgarbossa's Criteria]] is a validated clinical prediction rule based on ECG criteria to diagnose [[Acute Myocardial Infarction]] in patients with a [[Left Bundle Branch Block]]. It has good specificity, but poor sensitivity. | |||
==Major Points== | ==Major Points== | ||
'''The Sgarbossa Criteria:''' | '''The [[Sgarbossa Criteria]]:''' | ||
# ST-segment Elevation of at least 1 mm with concordance with the QRS complex with a score of 5 | # ST-segment Elevation of at least 1 mm with concordance with the QRS complex with a score of 5 | ||
# ST-segment depression in leads V1, V2 or V3 with a score of 3 | # ST-segment depression in leads V1, V2 or V3 with a score of 3 | ||
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===Inclusion Criteria=== | ===Inclusion Criteria=== | ||
* '''Experiment''': Patients with LBBB and Acute myocardial infarction (GUSTO-1 trial population)<ref>The GUSTO Investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med 1993;329:673-82</ref> | * '''Experiment''': Patients with [[LBBB]] and Acute myocardial infarction (GUSTO-1 trial population)<ref>The GUSTO Investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med 1993;329:673-82</ref> | ||
* '''Control''': Patients with normal documented angiography with LBBB Randomly selected from Duke data bank for cardiovascular disease<ref>Pryor DB, Califf RM, Harrell FE Jr, et al. Clinical data bases: accomplishments and unrealized potential. Med Care 1985;23:623-647</ref> | * '''Control''': Patients with normal documented angiography with LBBB Randomly selected from Duke data bank for cardiovascular disease<ref>Pryor DB, Califf RM, Harrell FE Jr, et al. Clinical data bases: accomplishments and unrealized potential. Med Care 1985;23:623-647</ref> | ||
===Exclusion Criteria=== | ===Exclusion Criteria=== | ||
Patients without LBBB | Patients without [[LBBB]] | ||
==Interventions== | ==Interventions== | ||
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===Primary Outcome=== | ===Primary Outcome=== | ||
Acute Myocardial Infarction | [[Acute Myocardial Infarction]] | ||
===Subgroup analysis=== | ===Subgroup analysis=== | ||
Revision as of 17:26, 21 April 2014
Under Review Journal Club Article
Sgarbossa E. et al.. "Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block. GUSTO-1 (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) Investigators". NEJM. 1996. 334(8):481-7.
PubMed Full text PDF
PubMed Full text PDF
Clinical Question
How can we diagnose Acute Myocardial Infarction in patients with a Left Bundle Branch Block?
Conclusion
Sgarbossa's Criteria is a validated clinical prediction rule based on ECG criteria to diagnose Acute Myocardial Infarction in patients with a Left Bundle Branch Block. It has good specificity, but poor sensitivity.
Major Points
The Sgarbossa Criteria:
- ST-segment Elevation of at least 1 mm with concordance with the QRS complex with a score of 5
- ST-segment depression in leads V1, V2 or V3 with a score of 3
- ST-segment Elevation of atleast 5 mm with discordance with the QRS complex with a score of 2
With a score >3 90% of those with positive criteria will have STEMI (Good Specificity) But with negative criteria it doesn't help that much (Low sensitivity)
Study Design
Population
Patient Demographics
- Median Age: 68 years
- Males: 64% in study group and 60% in experimental group
- Left Axis Deviation: 28% Vs. 48%
- Previous MI: 26% Vs. 59%
Inclusion Criteria
- Experiment: Patients with LBBB and Acute myocardial infarction (GUSTO-1 trial population)[1]
- Control: Patients with normal documented angiography with LBBB Randomly selected from Duke data bank for cardiovascular disease[2]
Exclusion Criteria
Patients without LBBB
Interventions
Outcomes
Primary Outcome
Subgroup analysis
Criticisms & Further Discussion
Funding
Grant from Bayer, Genentech, CIBA–Corning, ICI Pharmaceuticals, and Sanofi Pharmaceuticals.