Diagnosis of acute myocardial infarction in the presence of left bundle branch block.

Nestelberger, Thomas; Cullen, Louise; Lindahl, Bertil; Reichlin, Tobias; Greenslade, Jaimi H; Giannitsis, Evangelos; Christ, Michael; Morawiec, Beata; Miro, Oscar; Martín-Sánchez, Francisco Javier; Wussler, Desiree Nadine; Koechlin, Luca; Twerenbold, Raphael; Parsonage, William; Boeddinghaus, Jasper; Rubini Gimenez, Maria; Puelacher, Christian; Wildi, Karin; Buerge, Tobias; Badertscher, Patrick; ... (2019). Diagnosis of acute myocardial infarction in the presence of left bundle branch block. Heart (British Cardiac Society), 105(20), pp. 1559-1567. BMJ Publishing Group 10.1136/heartjnl-2018-314673

Full text not available from this repository. (Request a copy)

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 1 hour or 2 hours 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 0/2 hours allows early and accurate diagnosis of AMI in LBBB. TRIAL REGISTRATION NUMBER APACE: NCT00470587; ADAPT: ACTRN12611001069943; TRAPID-AMI: RD001107;Results.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Reichlin, Tobias Roman


600 Technology > 610 Medicine & health




BMJ Publishing Group




Daria Vogelsang

Date Deposited:

11 Dec 2019 11:05

Last Modified:

11 Dec 2019 11:05

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

ECG/electrocardiogram acute coronary syndromes acute myocardial infarction



Actions (login required)

Edit item Edit item
Provide Feedback