EBQ:Sgarbossa Criteria Study: Difference between revisions
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==Outcomes==
==Outcomes==
*Of th 26,003 ECGs 145 had the LBBB with 131 with confirmed myocardial infarction based on CKMB
*Using univariate analysis the ods rations for the individual criteria for STEMI in the presence of LBBB were:


{| class="wikitable"
| align="center" style="background:#f0f0f0;"|'''ST-segment elevation ≥ 1mm and concordant with QRS complex'''
| align="center" style="background:#f0f0f0;"|'''OR 25.2 (11.6-54.7)'''
|-
| ST-segment depression ≥ 1mm in lead V1, V2, V3||OR 6.0 (1.9-19.3)
|-
| ST-segment elevation ≥ 5mm and discordant with QRS complex||OR 4.3 (1.8-10.6)
|}
===Primary Outcome===
===Primary Outcome===
[[Acute Myocardial Infarction]]
[[Acute Myocardial Infarction]]

Revision as of 05:49, 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

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:

  1. ST-segment Elevation of at least 1 mm with concordance with the QRS complex with a score of 5
  2. ST-segment depression in leads V1, V2 or V3 with a score of 3
  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:
ST-segment elevation ≥ 1mm and concordant with QRS complex OR 25.2 (11.6-54.7)
ST-segment depression ≥ 1mm in lead V1, V2, V3 OR 6.0 (1.9-19.3)
ST-segment elevation ≥ 5mm and discordant with QRS complex OR 4.3 (1.8-10.6)

Primary Outcome

Acute Myocardial Infarction

Criticisms & Further Discussion

Funding

Grant from Bayer, Genentech, CIBA–Corning, ICI Pharmaceuticals, and Sanofi Pharmaceuticals.

Sources

  1. ↑ The GUSTO Investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med 1993;329:673-82
  2. ↑ Pryor DB, Califf RM, Harrell FE Jr, et al. Clinical data bases: accomplishments and unrealized potential. Med Care 1985;23:623-647
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