Annals of Emergency Medicine
Volume 52, Issue 4 , Pages 329-336.e1 , October 2008

Electrocardiographic Criteria for Detecting Acute Myocardial Infarction in Patients With Left Bundle Branch Block: A Meta-analysis

Presented at the Society for Academic Emergency Medicine, May 2006, San Francisco, CA.

  • Jeffrey A. Tabas, MD

      Affiliations

    • Department of Medicine, Division of Emergency Services, San Francisco General Hospital, University of California−San Francisco, San Francisco, CA
    • Corresponding Author InformationAddress for correspondence: Jeffrey A. Tabas, MD, Room 1E21, Emergency Services, San Francisco General Hospital, San Francisco, CA 94110; 415-206-5759, fax 415-206-5818
    • ,
  • Robert M. Rodriguez, MD

      Affiliations

    • Department of Medicine, Division of Emergency Services, San Francisco General Hospital, University of California−San Francisco, San Francisco, CA
    • ,
  • Hilary K. Seligman, MD

      Affiliations

    • Division of General Internal Medicine, San Francisco General Hospital, University of California−San Francisco, San Francisco, CA
    • ,
  • Nora F. Goldschlager, MD

      Affiliations

    • Division of Cardiology, San Francisco General Hospital, University of California−San Francisco, San Francisco, CA

Received 8 August 2006 ,Revised 29 October 2007 ,Accepted 4 December 2007.

References 

  1. Barron HV, Bowlby LJ, Breen T, et al. Use of reperfusion therapy for acute myocardial infarction in the United States: data from the National Registry of Myocardial Infarction 2. Circulation. 1998;97:1150–1156
  2. Sgarbossa EB, Pinski SL, Barbagelata A, 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). N Engl J Med. 1996;334:481–487
  3. Shlipak MG, Lyons WL, Go AS, et al. Should the electrocardiogram be used to guide therapy for patients with left bundle branch block and suspected myocardial infarction?. JAMA. 1999;281:714–719
  4. Gunnarsson G, Eriksson P, Dellborg M. ECG criteria in diagnosis of acute myocardial infarction in the presence of left bundle branch block. Int J Cardiol. 2001;78:167–174
  5. Eriksson P, Gunnarsson G, Dellborg M. Diagnosis of acute myocardial infarction in patients with chronic left bundle branch block (Standard 12-lead ECG compared to dynamic vectorcardiography). Scand Cardiovasc J. 1999;33:17–22
  6. Edhouse JA, Sakr M, Angus J, et al. Suspected myocardial infarction and left bundle branch block: electrocardiographic indicators of acute ischaemia. J Accid Emerg Med. 1999;16:331–335
  7. Sgarbossa EB. Value of the ECG in suspected acute myocardial infarction with left bundle branch block. J Electrocardiol. 2000;33(suppl):87–92
  8. Kasper DL, Harrison TR. Harrison's Manual of Medicine. 16th ed.. New York, NY: McGraw-Hill Medical Publishing Division; 2005;
  9. Fuster V, Hurst JW. Hurst's the Heart. 11th ed.. New York, NY: McGraw-Hill, Medical Pub. Division; 2004;
  10. Marx JA, Hockberger RS, Walls RM. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed.. Philadelphia, PA: Mosby/Elsevier; 2006;
  11. Tintinalli JE, Kelen GD, Stapczynski JS. Emergency Medicine: A Comprehensive Study Guide. 6th ed.. New York, NY: McGraw-Hill Medical Pub. Division; 2004;
  12. Zipes DP, Braunwald E. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 7th ed.. Philadelphia, PA: WB Saunders; 2005;
  13. Harwood-Nuss A. The Clinical Practice of Emergency Medicine. 3rd ed.. Philadelphia, PA: Lippincott William & Wilkins; 2001;
  14. Deeks JJ. Systematic reviews in health care: systematic reviews of evaluations of diagnostic and screening tests. BMJ. 2001;323:157–162
  15. Deville WL, Buntinx F, Bouter LM, et al. Conducting systematic reviews of diagnostic studies: didactic guidelines. BMC Med Res Methodol. 2002;2:9
  16. Moher D, Cook DJ, Eastwood S, et al. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement (Quality of Reporting of Meta-analyses). Lancet. 1999;354:1896–1900
  17. Glas AS, Lijmer JG, Prins MH, et al. The diagnostic odds ratio: a single indicator of test performance. J Clin Epidemiol. 2003;56:1129–1135
  18. Madias JE, Sinha A, Ashtiani R, et al. A critique of the new ST-segment criteria for the diagnosis of acute myocardial infarction in patients with left bundle branch block. Clin Cardiol. 2001;24:652–655
  19. Gula LJ, Dick A, Massel D. Diagnosing acute myocardial infarction in the setting of left bundle branch block: prevalence and observer variability from a large community study. Coron Artery Dis. 2003;14:387–393
  20. Kontos MC, McQueen RH, Jesse RL, et al. Can myocardial infarction be rapidly identified in emergency department patients who have left bundle branch block?. Ann Emerg Med. 2001;37:431–438
  21. Li SF, Walden PL, Marcilla O, et al. Electrocardiographic diagnosis of myocardial infarction in patients with left bundle branch block. Ann Emerg Med. 2000;36:561–565
  22. Maynard SJ, Menown IB, Manoharan G, et al. Body surface mapping improves early diagnosis of acute myocardial infarction in patients with chest pain and left bundle branch block. Heart. 2003;89:998–1002
  23. Sokolove PE, Sgarbossa EB, Amsterdam EA, et al. Interobserver agreement in the electrocardiographic diagnosis of acute myocardial infarction in patients with left bundle branch block. Ann Emerg Med. 2000;36:566–571
  24. Wong CK, French JK, Aylward PE, et al. Patients with prolonged ischemic chest pain and presumed-new left bundle branch block have heterogeneous outcomes depending on the presence of ST-segment changes. J Am Coll Cardiol. 2005;46:29–38
  25. Egger M, Smith GD, Altman DG. Systematic Reviews in Health Care: Meta-analysis in Context. 2nd ed.. London, England: BMJ; 2001;
  26. Fahy GJ, Pinski SL, Miller DP, et al. Natural history of isolated bundle branch block. Am J Cardiol. 1996;77:1185–1190
  27. Hardarson T, Arnason A, Eliasson GJ, et al. Left bundle branch block: prevalence, incidence, follow-up and outcome. Eur Heart J. 1987;8:1075–1079
  28. Eriksson P, Hansson PO, Eriksson H, et al. Bundle branch block in a general male population: the study of men born 1913. Circulation. 1998;98:2494–2500
  29. Kudenchuk PJ, Maynard C, Cobb LA, et al. Utility of the prehospital electrocardiogram in diagnosing acute coronary syndromes: the Myocardial Infarction Triage and Intervention (MITI) Project. J Am Coll Cardiol. 1998;32:17–27
  30. Menown IB, Mackenzie G, Adgey AA. Optimizing the initial 12-lead electrocardiographic diagnosis of acute myocardial infarction. Eur Heart J. 2000;21:275–283
  31. Pope JH, Ruthazer R, Kontos MC, et al. The impact of electrocardiographic left ventricular hypertrophy and bundle branch block on the triage and outcome of ED patients with a suspected acute coronary syndrome: a multicenter study. Am J Emerg Med. 2004;22:156–163
  32. Stenestrand U, Tabrizi F, Lindback J, et al. Comorbidity and myocardial dysfunction are the main explanations for the higher 1-year mortality in acute myocardial infarction with left bundle branch block. Circulation. 2004;110:1896–1902
  33. Go AS, Barron HV, Rundle AC, et al. Bundle branch block and in-hospital mortality in acute myocardial infarction (National Registry of Myocardial Infarction 2 Investigators). Ann Intern Med. 1998;129:690–697
  34. Panju AA, Hemmelgarn BR, Guyatt GH, et al. The rational clinical examination (Is this patient having a myocardial infarction?). JAMA. 1998;280:1256–1263
  35. Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction). Circulation. 2004;110:e82–e292
  36. Gershlick AH, Stephens-Lloyd A, Hughes S, et al. Rescue angioplasty after failed thrombolytic therapy for acute myocardial infarction. N Engl J Med. 2005;353:2758–2768
  37. Gibbons RJ, Balady GJ, Bricker JT, et al. ACC/AHA 2002 guideline update for exercise testing: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). Circulation. 2002;106:1883–1892

 Supervising editor: Judd E. Hollander, MD

 Author contributions: JAT, RMR, and NFG conceived of the study. JAT and RMR designed the trial and supervised data collection. JAT, RMR, and HKS analyzed the data. RMR and HKS provided statistical advice. JAT and RMR drafted the article, and all authors contributed substantially to its revision. JAT takes responsibility for the paper as a whole.

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.

 Publication dates: Available online March 17, 2008.

 Reprints not available from the authors.

PII: S0196-0644(07)01857-4

doi: 10.1016/j.annemergmed.2007.12.006

Annals of Emergency Medicine
Volume 52, Issue 4 , Pages 329-336.e1 , October 2008

Article Tools

* Image Usage & Resolution