Validation of the modified Sgarbossa criteria for acute coronary occlusion in the setting of left bundle branch block: A retrospective case-control study

H. Pendell Meyers, Alexander T. Limkakeng, Elias J. Jaffa, Anjni Patel, B. Jason Theiling, Salim R. Rezaie, Todd Stewart, Cassandra Zhuang, Vijaya K. Pera, Stephen W. Smith

Research output: Contribution to journalArticlepeer-review

32 Scopus citations

Abstract

Background The modified Sgarbossa criteria were proposed in a derivation study to be superior to the original criteria for diagnosing acute coronary occlusion (ACO) in left bundle branch block (LBBB). The new rule replaces the third criterion (5 mm of excessively discordant ST elevation [STE]) with a proportion (at least 1 mm STE and STE/S wave -0.25). We sought to validate the modified criteria. Methods This retrospective case-control study was performed by chart review in 2 tertiary care center emergency departments (EDs) and 1 regional referral center. A billing database was used at 1 site to identify all ED patients with LBBB and ischemic symptoms between May 2009 and June 2012. In addition, all 3 sites identified LBBB ACO patients who underwent emergent catheterization. We measured QRS amplitude and J-point deviation in all leads, blinded to outcomes. Acute coronary occlusion was determined by angiographic findings and cardiac biomarker levels, which were collected blinded to electrocardiograms. Diagnostic statistics of each rule were calculated and compared using McNemar's test. Results Our consecutive cohort search identified 258 patients: 9 had ACO, and 249 were controls. Among the 3 sites, an additional 36 cases of ACO were identified, for a total of 45 ACO cases and 249 controls. The modified criteria were significantly more sensitive than the original weighted criteria (80% vs 49%, P

Original languageEnglish (US)
Pages (from-to)1255-1264
Number of pages10
JournalAmerican Heart Journal
Volume170
Issue number6
DOIs
StatePublished - Dec 1 2015

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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