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Titolo:
Can myocardial infarction be rapidly identified in emergency department patients who have left bundle-branch block?
Autore:
Kontos, MC; McQueen, RH; Jesse, RL; Tatum, JL; Ornato, JP;
Indirizzi:
Virginia Commonwealth Univ, Med Coll Virginia, Dept Internal Med, Div Cardiol, Richmond, VA 23298 USA Virginia Commonwealth Univ Richmond VA USA 23298 , Richmond, VA 23298 USA Virginia Commonwealth Univ, Med Coll Virginia, Dept Emergency Med, Richmond, VA 23298 USA Virginia Commonwealth Univ Richmond VA USA 23298 , Richmond, VA 23298 USA Virginia Commonwealth Univ, Med Coll Virginia, Dept Radiol, Richmond, VA 23298 USA Virginia Commonwealth Univ Richmond VA USA 23298 , Richmond, VA 23298 USA
Titolo Testata:
ANNALS OF EMERGENCY MEDICINE
fascicolo: 5, volume: 37, anno: 2001,
pagine: 431 - 438
SICI:
0196-0644(200105)37:5<431:CMIBRI>2.0.ZU;2-7
Fonte:
ISI
Lingua:
ENG
Soggetto:
ST-SEGMENT ELEVATION; CORONARY-ARTERY DISEASE; Q-WAVE; ELECTROCARDIOGRAPHIC DIAGNOSIS; DILATED CARDIOMYOPATHY; ACC/AHA GUIDELINES; UNSTABLE ANGINA; TROPONIN-T; CHEST PAIN; OUTCOMES;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
38
Recensione:
Indirizzi per estratti:
Indirizzo: Kontos, MC 12th & Marshall St,POB 980051, Richmond, VA 23298 USA 12th & Marshall St,POB 980051 Richmond VA USA 23298 23298 USA
Citazione:
M.C. Kontos et al., "Can myocardial infarction be rapidly identified in emergency department patients who have left bundle-branch block?", ANN EMERG M, 37(5), 2001, pp. 431-438

Abstract

Study objectives: Fibrinolytic therapy is recommended for patients who have chest pain and left bundle-branch block (LBBB). However, the presence of baseline ECG abnormalities makes early accurate identification of acute myocardial infarction (AMI) difficult. The predictive ability of clinical and ECG variables far identifying patients with LBBB and AMI has not been well studied. We sought to determine the prevalence and predictors of myocardialinfarction among patients presenting to the emergency department with LBBBon the initial ECG who were evaluated for myocardial infarction. Methods: All patients presenting to the ED were prospectively risk stratified on the basis of clinical and historical variables. ECGs from patients with LBBB were compared retrospectively with previously published criteria for identification of AMI. The ability of a new LBBB to predict AMI was alsodetermined. Results: Twenty-four (13%) of the 182 patients with LBBB had AMI. Clinicaland historical variables were similar in patients with and without AMI. A new LBBB had a sensitivity of 42% and a specificity of 65%. The presence ofconcordant ST-segment elevation or depression had specificities and positive predictive values of 100%; however, sensitivities were only 8% and 17%, respectively. The best diagnostic criterion was the presence of concordant ST-segment elevation or depression on the ECG or an initially elevated creatine kinase MB (sensitivity, 63%; specificity, 99%). Conclusion: ECG criteria for identifying patients with AMI and LBBB identify only a small minority of patients with AMI. Treating all patients with LBBB and chest pain with fibrinolytics would result in treatment of a significant number of patients without AMI.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 30/03/20 alle ore 13:22:06