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

dc.contributor.author

Meyers, H Pendell

dc.contributor.author

Limkakeng, Alexander T

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Jaffa, Elias J

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Patel, Anjni

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Theiling, B Jason

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Rezaie, Salim R

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Stewart, Todd

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Zhuang, Cassandra

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Pera, Vijaya K

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Smith, Stephen W

dc.date.accessioned

2018-05-08T00:05:11Z

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2018-05-08T00:05:11Z

dc.date.issued

2015-12

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2018-05-08T00:05:10Z

dc.description.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.

dc.identifier

S0002-8703(15)00591-8

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0002-8703

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1097-6744

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https://hdl.handle.net/10161/16692

dc.language

eng

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Elsevier BV

dc.relation.ispartof

American heart journal

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10.1016/j.ahj.2015.09.005

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Humans

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Bundle-Branch Block

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Coronary Angiography

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Electrocardiography

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Sensitivity and Specificity

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Case-Control Studies

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Retrospective Studies

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Reproducibility of Results

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Aged

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Aged, 80 and over

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Middle Aged

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Female

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Male

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Acute Coronary Syndrome

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Coronary Occlusion

dc.title

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

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Journal article

duke.contributor.orcid

Limkakeng, Alexander T|0000-0002-9822-5595

duke.contributor.orcid

Patel, Anjni|0000-0002-8907-182X

pubs.issue

6

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School of Medicine

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Duke

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Surgery, Emergency Medicine

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Surgery

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Clinical Science Departments

pubs.publication-status

Published

pubs.volume

170

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