EBQ:Sgarbossa Criteria Study

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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 Left Bundle Branch Block patients ?

Conclusion

A Validated Clinical prediction rule has been Developed based on ECG criteria to Diagnose Acute Myocardial infarction in Left Bundle Branch Patients

Major Points

The Sgarbossa Criteria:

  1. ST-segment Elevation of at least 1 mm with concordance with the QRS complex
  2. ST-segment depression in leads V1, V2 or V3
  3. ST-segment Elevation of atleast 5 mm with discordance with the QRS complex

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

Acute Myocardial Infarction

Subgroup analysis

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