医学
心脏病学
内科学
QRS波群
算法
左束支阻滞
束支阻滞
心肌梗塞
经皮冠状动脉介入治疗
队列
心电图
右束支阻滞
心力衰竭
计算机科学
作者
Andrea Di Marco,Marcos Rodríguez,Juan Cinca,Antoni Bayés‐Genís,Josè T. Ortiz-Pérez,Albert Ariza‐Solé,José Carlos Sánchez‐Salado,Alessandro Sionís,J Rodríguez,Beatriz Toledano,Pau Codina,Eduard Solé‐González,Mónica Masotti,Joan Antoni Gómez‐Hospital,Ángel Cequier,Ignasi Anguera
标识
DOI:10.1161/jaha.119.015573
摘要
Background Current electrocardiographic algorithms lack sensitivity to diagnose acute myocardial infarction ( AMI ) in the presence of left bundle branch block. Methods and Results A multicenter retrospective cohort study including consecutive patients with suspected AMI and left bundle branch block, referred for primary percutaneous coronary intervention between 2009 and 2018. Pre‐2015 patients formed the derivation cohort (n=163, 61 with AMI ); patients between 2015 and 2018 formed the validation cohort (n=107, 40 with AMI ). A control group of patients without suspected AMI was also studied (n=214). Different electrocardiographic criteria were tested. A total of 484 patients were studied. A new electrocardiographic algorithm ( BARCELONA algorithm) was derived and validated. The algorithm is positive in the presence of ST deviation ≥1 mm (0.1 mV) concordant with QRS polarity, in any lead, or ST deviation ≥1 mm (0.1 mV) discordant with the QRS , in leads with max (R|S) voltage (the voltage of the largest deflection of the QRS , ie, R or S wave) ≤6 mm (0.6 mV). In both the derivation and the validation cohort, the BARCELONA algorithm achieved the highest sensitivity (93%–95%), negative predictive value (96%–97%), efficiency (91%–94%) and area under the receiver operating characteristic curve (0.92–0.93), significantly higher than previous electrocardiographic rules ( P <0.01); the specificity was good in both groups (89%–94%) as well as the control group (90%). Conclusions In patients with left bundle branch block referred for primary percutaneous coronary intervention , the BARCELONA algorithm was specific and highly sensitive for the diagnosis of AMI , leading to a diagnostic accuracy comparable to that obtained by ECG in patients without left bundle branch block.
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