Diagnosis of acute myocardial infarction in the presence of left bundle branch block

Nestelberger, Thomas and Cullen, Louise and Lindahl, Bertil and Reichlin, Tobias and Greenslade, Jaimi H. and Giannitsis, Evangelos and Christ, Michael and Morawiec, Beata and Miro, Oscar and Martín-Sánchez, Francisco Javier and Wussler, Desiree Nadine and Koechlin, Luca and Twerenbold, Raphael and Parsonage, William and Boeddinghaus, Jasper and Rubini Gimenez, Maria and Puelacher, Christian and Wildi, Karin and Buerge, Tobias and Badertscher, Patrick and DuFaydeLavallaz, Jeanne and Strebel, Ivo and Croton, Lukas and Bendig, Garnet and Osswald, Stefan and Pickering, John William and Than, Martin and Mueller, Christian and Apace, Adapt. (2019) Diagnosis of acute myocardial infarction in the presence of left bundle branch block. Heart (British Cardiac Society), 105 (20). pp. 1559-1567.

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Official URL: https://edoc.unibas.ch/77033/

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Patients with suspected acute myocardial infarction (AMI) in the setting of left bundle branch block (LBBB) present an important diagnostic and therapeutic challenge to the clinician.; We prospectively evaluated the incidence of AMI and diagnostic performance of specific ECG and high-sensitivity cardiac troponin (hs-cTn) criteria in patients presenting with chest discomfort to 26 emergency departments in three international, prospective, diagnostic studies. The final diagnosis of AMI was centrally adjudicated by two independent cardiologists according to the universal definition of myocardial infarction.; Among 8830 patients, LBBB was present in 247 (2.8%). AMI was the final diagnosis in 30% of patients with LBBB, with similar incidence in those with known LBBB versus those with presumably new LBBB (29% vs 35%, p=0.42). ECG criteria had low sensitivity (1%-12%) but high specificity (95%-100%) for AMI. The diagnostic accuracy as quantified by the receiver operating characteristics (ROC) curve of hs-cTnT and hs-cTnI concentrations at presentation (area under the ROC curve (AUC) 0.91, 95% CI 0.85 to 0.96 and AUC 0.89, 95% CI 0.83 to 0.95), as well as that of their 0/1-hour and 0/2-hour changes, was very high. A diagnostic algorithm combining ECG criteria with hs-cTnT/I concentrations and their absolute changes at 1 hour or 2 hours derived in cohort 1 (45 of 45(100%) patients with AMI correctly identified) showed high efficacy and accuracy when externally validated in cohorts 2 and 3 (28 of 29 patients, 97%).; Most patients presenting with suspected AMI and LBBB will be found to have diagnoses other than AMI. Combining ECG criteria with hs-cTnT/I testing at 0/1 hour or 0/2 hours allows early and accurate diagnosis of AMI in LBBB.; APACE: NCT00470587; ADAPT: ACTRN12611001069943; TRAPID-AMI: RD001107;Results.
Faculties and Departments:03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Kardiologie > Klinische Outcomeforschung Kardiologie (Müller)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Kardiologie > Klinische Outcomeforschung Kardiologie (Müller)
UniBasel Contributors:Nestelberger, Thomas and Müller, Christian
Item Type:Article, refereed
Article Subtype:Research Article
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:08 Dec 2020 08:51
Deposited On:18 Aug 2020 16:56

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