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Diagnosis of acute ...
Diagnosis of acute myocardial infarction in the presence of left bundle branch block
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- Nestelberger, Thomas (författare)
- Univ Hosp Basel, CRIB, Basel, Switzerland
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- Cullen, Louise (författare)
- Royal Brisbane & Womens Hosp, Emergency Dept, Brisbane, Qld, Australia
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- Lindahl, Bertil, 1957- (författare)
- Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)
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- Reichlin, Tobias (författare)
- Univ Hosp Bern, Dept Cardiol, Bern, Switzerland
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- Greenslade, Jaimi H. (författare)
- Royal Brisbane & Womens Hosp, Emergency Dept, Brisbane, Qld, Australia
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- Giannitsis, Evangelos (författare)
- Univ Klinikum Heidelberg, Dept Cardiol, Heidelberg, Germany
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- Christ, Michael (författare)
- Luzerner Kantonsspital, Dept Emergency Med, Luzern, Switzerland
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- Morawiec, Beata (författare)
- Univ Hosp, Dept Cardiol, Zabrze, Poland
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- Miro, Oscar (författare)
- Hosp Clin Barcelona, Dept Emergency Dept, Barcelona, Spain
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- Javier Martin-Sanchez, Francisco (författare)
- Hosp San Carlos Madrid, Emergency Dept, Madrid, Spain
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- Wussler, Desiree Nadine (författare)
- Univ Hosp Basel, CRIB, Basel, Switzerland
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- Koechlin, Luca (författare)
- Univ Hosp Basel, CRIB, Basel, Switzerland
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- Twerenbold, Raphael (författare)
- Univ Hosp Basel, CRIB, Basel, Switzerland
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- Parsonage, William (författare)
- Royal Brisbane & Womens Hosp, Dept Cardiol, Brisbane, Qld, Australia
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- Boeddinghaus, Jasper (författare)
- Univ Hosp Basel, CRIB, Basel, Switzerland
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- Gimenez, Maria Rubini (författare)
- Univ Hosp Basel, CRIB, Basel, Switzerland
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- Puelacher, Christian (författare)
- Univ Hosp Basel, CRIB, Basel, Switzerland
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- Wildi, Karin (författare)
- Univ Hosp Basel, CRIB, Basel, Switzerland
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- Buerge, Tobias (författare)
- Univ Hosp Basel, CRIB, Basel, Switzerland
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- Badertscher, Patrick (författare)
- Univ Hosp Basel, CRIB, Basel, Switzerland
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- DuFaydeLavallaz, Jeanne (författare)
- Univ Hosp Basel, CRIB, Basel, Switzerland
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- Strebel, Ivo (författare)
- Univ Hosp Basel, CRIB, Basel, Switzerland
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- Croton, Lukas (författare)
- Univ Hosp Basel, CRIB, Basel, Switzerland
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- Bendig, Garnet (författare)
- Entwicklungs & Produktionszentrum, Roche Forsch, Penzberg, Germany
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- Osswald, Stefan (författare)
- Univ Hosp Basel, CRIB, Basel, Switzerland
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- Pickering, John William (författare)
- Univ Hosp Basel, CRIB, Basel, Switzerland;Univ Otago, Dept Med, Dunedin, New Zealand
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- Than, Martin (författare)
- Univ Hosp Basel, CRIB, Basel, Switzerland;Christchurch Hosp, Emergency Dept, Christchurch, New Zealand
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- Mueller, Christian (författare)
- Univ Hosp Basel, CRIB, Basel, Switzerland
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(creator_code:org_t)
- 2019-05-29
- 2019
- Engelska.
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Ingår i: Heart. - : BMJ PUBLISHING GROUP. - 1355-6037 .- 1468-201X. ; 105:20, s. 1559-1567
- Relaterad länk:
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https://edoc.unibas....
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
Ämnesord
Stäng
- Objective: Patients with suspected acute myocardial infarction (AMI) in the setting of left bundle branch block (LBBB) present an important diagnostic and therapeutic challenge to the clinician.Methods: We prospectively evaluated the incidence of AMI and diagnostic performance of specific ECG and high-sensitivity cardiac troponin (hs-cTn) criteria in patients presenting with chest discomfort to 26 emergency departments in three international, prospective, diagnostic studies. The final diagnosis of AMI was centrally adjudicated by two independent cardiologists according to the universal definition of myocardial infarction.Results: Among 8830 patients, LBBB was present in 247 (2.8%). AMI was the final diagnosis in 30% of patients with LBBB, with similar incidence in those with known LBBB versus those with presumably new LBBB (29% vs 35%, p=0.42). ECG criteria had low sensitivity (1%-12%) but high specificity (95%-100%) for AMI. The diagnostic accuracy as quantified by the receiver operating characteristics (ROC) curve of hs-cTnT and hs-cTnI concentrations at presentation (area under the ROC curve (AUC) 0.91, 95%CI 0.85 to 0.96 and AUC 0.89, 95%CI 0.83 to 0.95), as well as that of their 0/1-hour and 0/2-hour changes, was very high. A diagnostic algorithm combining ECG criteria with hs-cTnT/I concentrations and their absolute changes at 1hour or 2hours derived in cohort 1 (45 of 45(100%) patients with AMI correctly identified) showed high efficacy and accuracy when externally validated in cohorts 2 and 3 (28 of 29 patients, 97%).Conclusion: Most patients presenting with suspected AMI and LBBB will be found to have diagnoses other than AMI. Combining ECG criteria with hs-cTnT/I testing at 0/1 hour or 0/2hours allows early and accurate diagnosis of AMI in LBBB.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Nyckelord
- acute coronary syndromes
- acute myocardial infarction
- ECG
- electrocardiogram
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- ref (ämneskategori)
- art (ämneskategori)
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Heart
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- Av författaren/redakt...
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Nestelberger, Th ...
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Cullen, Louise
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Lindahl, Bertil, ...
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Reichlin, Tobias
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Greenslade, Jaim ...
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Giannitsis, Evan ...
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visa fler...
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Christ, Michael
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Morawiec, Beata
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Miro, Oscar
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Javier Martin-Sa ...
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Wussler, Desiree ...
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Koechlin, Luca
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Twerenbold, Raph ...
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Parsonage, Willi ...
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Boeddinghaus, Ja ...
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Gimenez, Maria R ...
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Puelacher, Chris ...
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Wildi, Karin
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Buerge, Tobias
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Badertscher, Pat ...
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DuFaydeLavallaz, ...
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Strebel, Ivo
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Croton, Lukas
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Bendig, Garnet
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Osswald, Stefan
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Pickering, John ...
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Than, Martin
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Mueller, Christi ...
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- MEDICIN OCH HÄLSOVETENSKAP
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Heart
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Uppsala universitet