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

Abstract

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.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.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 < .001) and unweighted criteria (80% vs 56%, P < .001). Specificity of the modified criteria was not statistically different from the original weighted criteria (99% vs 100%, P = .5) but was significantly greater than the original unweighted criteria (99% vs 94%, P = .004).The modified Sgarbossa criteria were superior to the original criteria for identifying ACO in LBBB.

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Published Version (Please cite this version)

10.1016/j.ahj.2015.09.005

Publication Info

Meyers, H Pendell, Alexander T Limkakeng, Elias J Jaffa, Anjni Patel, B Jason Theiling, Salim R Rezaie, Todd Stewart, Cassandra Zhuang, et al. (2015). Validation of the modified Sgarbossa criteria for acute coronary occlusion in the setting of left bundle branch block: A retrospective case-control study. American heart journal, 170(6). 10.1016/j.ahj.2015.09.005 Retrieved from https://hdl.handle.net/10161/16692.

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Scholars@Duke

Limkakeng

Alexander Tan Limkakeng

Professor of Emergency Medicine

Dr. Alexander T. Limkakeng, Jr., MD, MHSc, FACEP is a Professor of Emergency Medicine, Vice Chair of Clinical Research, Director of the Acute Care Research Team, and Director of the Resident Research Fellowship for the Department of Emergency Medicine in the Duke University School of Medicine in Durham, North Carolina.

Dr. Limkakeng has served as chair of the American College of Emergency Physicians (ACEP) Research Committee, and been the Course Director of the ACEP Research Forum from 2016-2018, the largest emergency medical research platform in the nation. He is also the Assistant Director of ACEP’s Emergency Medicine Basic Research Skills course. He was elected to the Nominating Committee of the Society of Academic Emergency Medicine.

As a researcher, Dr. Limkakeng has led multiple clinical trials and interdepartmental sponsored projects and is author on over 100 peer-reviewed manuscripts. These include studies in emergency conditions such as COVID-19, traumatic brain injury, hypertension, heart failure, thrombosis, stroke, envenomations, and septic shock. His research has been funded by grants and contracts totaling over $9 million dollars. He has lectured internationally on acute coronary syndrome, responsible conduct of research, design of clinical trials, and precision medicine in emergency care. He has led Duke’s involvement in NIH-funded research networks and in industry-funded work that led to FDA approval for multiple high-sensitivity cardiac troponin assays and point-of-care COVID-19 diagnostic tests. He has servesd as Co-PI for the Duke U24 Hub in the NIH Early Phase Pain Investigation Clinical Network (EPPIC-Net) (1U24NS114416) and now serves as a co-PI on the Duke U24 Hub award (1U24NS129498) in the NIH Strategies to Innovate Emergency Care Clinical Trials (SIREN) Network and in the NIH NINDS Strokenet network (1U24NS135250)

His personal research interest is finding new ways to diagnose acute coronary syndrome. In particular, he is interested in novel biomarkers and precision medicine approaches to this problem. The common element throughout this work is a focus on time-sensitive health conditions.
Joiner

Anjni Patel Joiner

Associate Professor of Emergency Medicine

Anjni Joiner, DO, MPH, FACEP, FAEMS is an Assistant Professor of Emergency Medicine at Duke University School of Medicine. Dr. Joiner serves as Medical Director of Prehospital Medicine at Duke University Hospital, overseeing the Emergency Medical Services section within the Department of Emergency Medicine. She also serves as the Medical Director for Durham County EMS, providing medical oversight to all county agencies, including EMS, first responders, and the Durham Emergency Call Center. In these roles, she strives to work collaboratively with community partners to provide care to underserved and underrepresented populations. These efforts include development of Community Paramedicine programs to address opioid use disorder in Durham Community through harm reduction techniques and partnering with organizations such as the City of Durham HEART team for unarmed police response.

Her research interests include injury prevention and trauma, development and strengthening of prehospital emergency care systems internationally, and improving access to care. Her current projects include a comprehensive assessment of the emergency care system in Moshi, Tanzania through a community needs and hospital capacity assessment and development of a prehospital emergency care system evaluation tool (PECSET) for underdeveloped EMS systems in South and Southeast Asia.

Theiling

Brent Jason Theiling

Associate Professor of Emergency Medicine

 

Dr. Theiling is a board-certified emergency medicine physician with expertise in Emergency Department and hospital operations. He is currently the vice chair of operations for Duke University's Department of Emergency Medicine, as well as CSU Medical Director of the Emergency Services Clinical Service Unit for Duke University Hospital. This unit encompasses Duke's Emergency Department, Life Flight Critical Care transport teams, the Duke Trauma Center, Patient Transport and Emergency Management.

As an Associate Professor of Emergency Medicine at Duke University School of Medicine and works in providing high-quality emergency care.. Dr. Theiling also provides cutting-edge education to future emergency medicine providers, focusing on clinical emergency medicine and critical care, advancements in medical education and emergency department operations.

Dr. Theiling is also a member of the Duke Emergency Medicine Residency Core Faculty and has won multiple awards for his work in education and clinical care. He has over a dozen publications in peer-reviewed journals about clinical emergency medicine, advancements in medical education, emergency department operations and work with Duke Life Flight. He works closely with AMPA and is active in the organization.


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