| 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. | |
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MedLine Citation:
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PMID: 8559200 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The presence of left bundle-branch block on the electrocardiogram may conceal the changes of acute myocardial infarction, which can delay both its recognition and treatment. We tested electrocardiographic criteria for the diagnosis of acute infarction in the presence of left bundle-branch block. METHODS: The base-line electrocardiograms of patients enrolled in the GUSTO-1 (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) trial who had left bundle-branch block and acute myocardial infarction confirmed by enzyme studies were blindly compared with the electrocardiograms of control patients who had chronic coronary artery disease and left bundle-branch block. The electrocardiographic criteria for the diagnosis of infarction were then tested in an independent sample of patients presenting with acute chest pain and left bundle-branch block. RESULTS: Of 26,003 North American patients, 131 (0.5 percent) with acute myocardial infarction had left bundle-branch block. The three electrocardiographic criteria with independent value in the diagnosis of acute infarction in these patients were an ST-segment elevation of 1 mm or more that was concordant with (in the same direction as) the QRS complex; ST-segment depression of 1 mm or more in lead V1, V2, or V3; and ST-segment elevation of 5 mm or more that was disconcordant with (in the opposite direction from) the QRS complex. We used these three criteria in a multivariate model to develop a scoring system (0 to 10), which allowed a highly specific diagnosis of acute myocardial infarction to be made. CONCLUSIONS: We developed and validated a clinical prediction rule based on a set of electrocardiographic criteria for the diagnosis of acute myocardial infarction in patients with chest pain and left bundle-branch block. The use of these criteria, which are based on simple ST-segment changes, may help identify patients with acute myocardial infarction, who can then receive appropriate treatment. |
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Authors:
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E B Sgarbossa; S L Pinski; A Barbagelata; D A Underwood; K B Gates; E J Topol; R M Califf; G S Wagner |
Publication Detail:
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Type: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The New England journal of medicine Volume: 334 ISSN: 0028-4793 ISO Abbreviation: N. Engl. J. Med. Publication Date: 1996 Feb |
Date Detail:
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Created Date: 1996-02-23 Completed Date: 1996-02-23 Revised Date: 2010-03-24 |
Medline Journal Info:
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Nlm Unique ID: 0255562 Medline TA: N Engl J Med Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 481-7 Citation Subset: AIM; IM |
Affiliation:
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Cleveland Clinic Foundation, Department of Cardiology, OH 44195, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Analysis of Variance Bundle-Branch Block / complications* Case-Control Studies Electrocardiography* Female Humans Logistic Models Male Middle Aged Myocardial Infarction / complications, diagnosis* ROC Curve Sensitivity and Specificity |
| Comments/Corrections | |
Comment In:
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N Engl J Med. 1996 Jul 11;335(2):131-2; author reply 133
[PMID:
8649478
]
N Engl J Med. 1996 Jul 11;335(2):132; author reply 133 [PMID: 8649479 ] N Engl J Med. 1996 Jul 11;335(2):133 [PMID: 8649481 ] N Engl J Med. 1996 Feb 22;334(8):528-9 [PMID: 8559208 ] N Engl J Med. 1996 Jul 11;335(2):132-3 [PMID: 8649480 ] |
Erratum In:
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N Engl J Med 1996 Apr 4;334(14):931 |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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