Related Experiment Video
Updated: Aug 5, 2026
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Simplifying thrombolysis decisions in patients with left bundle branch block
1Musgrove Park Hospital, Toaunton, Exeter, UK. adamreuben@hotmail.com
Insights
A simplified algorithm for chest pain and left bundle branch block (LBBB) improves appropriate thrombolysis for acute myocardial infarction (AMI). This new tool aids emergency department doctors in making better treatment decisions for LBBB patients.
Area of Science:
- Cardiology
- Emergency Medicine
- Medical Algorithms
Background:
- Patients with chest pain and left bundle branch block (LBBB) have poorer outcomes.
- Thrombolysis is underutilized in acute myocardial infarction (AMI) with LBBB.
- Current decision algorithms for LBBB management are complex.
Purpose of the Study:
- To redesign and simplify the Sgarbossa criteria-based algorithm for managing chest pain and LBBB.
- To compare the reliability of the simplified algorithm against the existing one.
Main Methods:
- A simplified algorithm was developed and tested against the current one.
- Emergency physicians evaluated ECGs using both algorithms.
- Six ECGs with proven AMI were used to assess thrombolysis decisions.
Main Results:
- The new algorithm increased appropriate thrombolysis and reduced inappropriate use.
- Specificity for AMI improved from 0.85 to 0.99.
- Sensitivity for AMI increased from 0.38 to 0.6, with better agreement to the gold standard.
Conclusions:
- Cognitive difficulties with the current algorithm contribute to under-treatment.
- The proposed simplified algorithm aids appropriate thrombolysis for AMI in LBBB patients.
- This tool can improve patient outcomes by facilitating timely and correct treatment.
Objectives:
To redesign and simplify an existing decision algorithm for the management of patients who present to the emergency department with chest pain and left bundle branch block (LBBB) based on the Sgarbossa criteria. To compare its reliability with the current algorithm.
Methods:
A simplified algorithm was created and tested against the existing algorithm. Electrocardiograms (ECGs) of patients with LBBB were presented to 10 emergency department doctors with both old and new algorithms a week apart. Six ECGs displayed the relevant criteria for thrombolysis and had proven acute myocardial infarction (AMI) based on a gold standard of enzyme measurements. Subjects were asked whether or not they would thrombolyse a patient presenting with the given ECG using each of the algorithms as a guide.
Results:
The new algorithm has demonstrated improvements in terms of an increase in appropriate thrombolysis and a reduction in inappropriate thrombolysis. Specificity for AMI rose from 0.85 to 0.99 and sensitivity from 0.38 to 0.6. kappa score showed greater agreement with the gold standard.
Conclusion:
Patients with AMI and LBBB have a significantly poorer outcome than those without LBBB. Despite this, thrombolysis is less likely to be given to patients with AMI and LBBB. This study demonstrates that in part this is because of cognitive difficulties using the current algorithm. The proposed proforma addresses these issues and provides a simple tool to aid appropriate treatment in this group of patients.
Related Concept Videos
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
01:24Cardiac Catheterization III: Left Heart Catheterization
01:30Acute Coronary Syndrome I: Introduction
01:27Peripheral Artery Disease III: Interprofessional Care
01:29Venous Thrombosis III: Interprofessional Care
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care