2025/01/01 by José Nunes de Alencar, Gleydson Wesley Freire Lima, Haissa Assad dos Santos Geraldo +4
Medicine · #Acute Myocardial Infarction Research #Cardiac Imaging and Diagnostics #Cardiovascular Function and Risk Factors
paper · doi:10.36660/abc.20250109
crossref issued 2025/01/01 · crossref published 2025/01/01 · crossref published-online 2025/01/01 · openalex publication_date 2025/01/01 · openalex created_date 2025/11/04 · crossref created 2025/11/04 · crossref deposited 2025/11/04 · crossref indexed 2026/08/03 · openalex updated_date 2026/08/04
BACKGROUND: The diagnostic utility of new or presumed new left bundle branch block (LBBB) for acute myocardial infarction (AMI) in the setting of acute coronary syndrome (ACS) remains controversial. OBJECTIVE: To evaluate whether the timing of LBBB predicts AMI and to compare its diagnostic accuracy with ischemic electrocardiography (ECG) criteria, particularly the Modified Sgarbossa Criteria (MSC). METHODS: We searched PubMed and Scopus for studies involving patients with ACS with LBBB through December 2023. Sensitivity, specificity, positive (LR+) and negative (LR-) likelihood ratios, and diagnostic odds ratios (DOR) were calculated to assess diagnostic accuracy. Incidence and mortality data were also analyzed. Risk of bias was evaluated using the Newcastle-Ottawa Scale (NOS) and the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. RESULTS: A total of 51 studies were included. LBBB occurred in 3.3% of ACS presentations and was associated with higher in-hospital mortality. Differentiating new from old LBBB was diagnostically neutral: LR+ 1.30 (95% CI: 0.75 to 1.85), LR- 0.90 (95% CI: 0.79 to 1.02), and DOR 1.44 (95% CI: 0.93 to 2.24); all confidence intervals crossed the null value of 1.0. In contrast, MSC demonstrated 83.6% sensitivity (95% CI: 55.4 to 95.5%) and 92.6% specificity (95% CI: 78.9 to 97.7%) for angiographically confirmed occlusive AMI, with LR+ 11.34 (95% CI: 3.67 to 34.99) and LR- 0.18 (95% CI: 0.054 to 0.575). CONCLUSION: LBBB chronology alone does not significantly impact the likelihood of AMI. Ischemic ECG criteria - especially the MSC - provide substantially greater diagnostic accuracy and should guide clinical decision-making in ACS patients with LBBB.