EBQ:Sgarbossa Criteria Study: Difference between revisions
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==Criticisms & Further Discussion== | ==Criticisms & Further Discussion== | ||
*The Sgarbossa criteria have not been incorporated into the AHA STEMI guidelines and new LBBB has been removed from the current AHA recommendations for activation of PCI. | *The Sgarbossa criteria have not been incorporated into the AHA STEMI guidelines and new LBBB has been removed from the current AHA recommendations for activation of PCI.<ref>Q. Cai, N. Mehta, E.B. Sgarbossa, S.L. Pinski, G.S. Wagner, R.M. Califf, and A. Barbagelata, "The left bundle-branch block puzzle in the 2013 ST-elevation myocardial infarction guideline: from falsely declaring emergency to denying reperfusion in a high-risk population. Are the Sgarbossa Criteria ready for prime time?", American heart journal, 2013.[http://www.ncbi.nlm.nih.gov/pubmed/24016487 PDF]</ref> | ||
*Although the criteria is highly specific it lacks sensitivity and can result in excess cath lab | *Although the criteria is highly specific it lacks sensitivity and can result in excess cath lab activation.<ref>D.M. Larson, K.M. Menssen, S.W. Sharkey, S. Duval, R.S. Schwartz, J. Harris, J.T. Meland, B.T. Unger, and T.D. Henry, ""False-positive" cardiac catheterization laboratory activation among patients with suspected ST-segment elevation myocardial infarction.", JAMA : the journal of the American Medical Association, 2007</ref> | ||
==Funding== | ==Funding== | ||
Revision as of 09:30, 26 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)
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
Outcomes
- Using univariate analysis the ods rations for the individual criteria for STEMI in the presence of LBBB were:
| Criteria | Odds Ratio |
| ST-segment elevation ≥ 1mm and concordant with QRS complex | 25.2 (11.6-54.7) |
| ST-segment depression ≥ 1mm in lead V1, V2, V3 | 6.0 (1.9-19.3) |
| ST-segment elevation ≥ 5mm and discordant with QRS complex | 4.3 (1.8-10.6) |
Primary Outcome
Criticisms & Further Discussion
- The Sgarbossa criteria have not been incorporated into the AHA STEMI guidelines and new LBBB has been removed from the current AHA recommendations for activation of PCI.[3]
- Although the criteria is highly specific it lacks sensitivity and can result in excess cath lab activation.[4]
Funding
Grant from Bayer, Genentech, CIBA–Corning, ICI Pharmaceuticals, and Sanofi Pharmaceuticals.
Sources
- ↑ The GUSTO Investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med 1993;329:673-82
- ↑ Pryor DB, Califf RM, Harrell FE Jr, et al. Clinical data bases: accomplishments and unrealized potential. Med Care 1985;23:623-647
- ↑ Q. Cai, N. Mehta, E.B. Sgarbossa, S.L. Pinski, G.S. Wagner, R.M. Califf, and A. Barbagelata, "The left bundle-branch block puzzle in the 2013 ST-elevation myocardial infarction guideline: from falsely declaring emergency to denying reperfusion in a high-risk population. Are the Sgarbossa Criteria ready for prime time?", American heart journal, 2013.PDF
- ↑ D.M. Larson, K.M. Menssen, S.W. Sharkey, S. Duval, R.S. Schwartz, J. Harris, J.T. Meland, B.T. Unger, and T.D. Henry, ""False-positive" cardiac catheterization laboratory activation among patients with suspected ST-segment elevation myocardial infarction.", JAMA : the journal of the American Medical Association, 2007