Universität zu Köln

Wegmann, Christian, Pfister, Roman, Scholz, Steffen, Markhof, Anne, Wanke, Sebastian, Kuhr, Kathrin, Rudolph, Tanja, Baldus, Stephan and Reuter, Hannes (2015). Diagnostic value of left bundle branch block in patients with acute myocardial infarction. A prospective analysis. Herz, 40 (8). S. 1107 - 1115. MUNICH: URBAN & VOGEL. ISSN 1615-6692

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Abstract

In contemporary practice with early catheterization in most patients with suspected acute myocardial infarction, the clinical utility of new or presumably new left bundle branch block (LBBB) as a diagnostic criterion equivalent to ST-segment elevation is not well established. This study therefore aimed to determine the predictive value of LBBB for the diagnosis of acute transmural myocardial infarction (or ST-segment elevation myocardial infarction, STEMI). Between November 2006 and December 2011, 1,139 consecutive patients presenting to the heart center of the University of Cologne with suspected STEMI were examined. Of these patients, 935 presented with ST elevation, 72 with LBBB, and 132 had neither of these ECG changes. The diagnosis was confirmed with immediate coronary angiography. Compared with ST-segment elevation, LBBB was associated with a higher prevalence of cardiovascular risk factors and end-organ damage, and more patients with LBBB presented with pulmonary edema or cardiogenic shock (Killip III/IV). STEMI was confirmed in 58.3 % of patients with LBBB and in 86.4 % with ST-segment elevation. The sensitivity (0.38 [0.29-0.46]; odds ratio: 1.24) and specificity (0.67 [0.58-0.77]) of LBBB for the prediction of STEMI were low. However, the additional assessment of troponin T (> 0.1 A mu g/l) increased the predictive value of LBBB significantly. After adjusting for age and gender, no difference in mortality was found between the groups. LBBB with acute chest pain characterizes a cohort of patients with high morbidity and mortality. For the triage of these patients at first contact, additional criteria should be evaluated, which could increase the specificity of LBBB for the diagnosis of STEMI.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Wegmann, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Pfister, Roman UNSPECIFIED UNSPECIFIED UNSPECIFIED Scholz, Steffen UNSPECIFIED UNSPECIFIED UNSPECIFIED Markhof, Anne UNSPECIFIED UNSPECIFIED UNSPECIFIED Wanke, Sebastian UNSPECIFIED UNSPECIFIED UNSPECIFIED Kuhr, Kathrin UNSPECIFIED UNSPECIFIED UNSPECIFIED Rudolph, Tanja UNSPECIFIED UNSPECIFIED UNSPECIFIED Baldus, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Reuter, Hannes UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-385157
DOI:	10.1007/s00059-015-4326-z
Journal or Publication Title:	Herz
Volume:	40
Number:	8
Page Range:	S. 1107 - 1115
Date:	2015
Publisher:	URBAN & VOGEL
Place of Publication:	MUNICH
ISSN:	1615-6692
Language:	German
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ST-SEGMENT ELEVATION; GUIDELINES; STREPTOKINASE; MANAGEMENT; MORBIDITY; MORTALITY; ASSAYS; POINT; RULE Multiple languages Cardiac & Cardiovascular Systems Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/38515