ECG evaluation in patients with pacemaker and suspected acute coronary syndrome: Which score should we apply?
Pedro Freitas1, Miguel Borges Santos1, Mariana Faria1
1Cardiology Department, Hospital de Santa Cruz, Avenida Professor Doutor Reinaldo dos Santos, 2790-134 Carnaxide, Lisbon, Portugal.
Insights
Diagnosing ST-elevation myocardial infarction (STEMI) in patients with left bundle branch block (LBBB) from right ventricular pacing is challenging. This study compared Sgarbossa's, Selvester's, and Smith's scores, finding sequential application clinically useful.
Area of Science:
- Cardiology
- Electrocardiography
- Medical Diagnostics
Background:
- Right ventricular pacing can mimic left bundle branch block (LBBB) on ECG.
- Accurate diagnosis of ST-elevation myocardial infarction (STEMI) in LBBB patients is critical.
- Existing diagnostic criteria for STEMI in LBBB require validation in pacemaker populations.
Purpose of the Study:
- To validate and compare the diagnostic performance of Sgarbossa's, Selvester's, and Smith's scores for STEMI in patients with LBBB due to right ventricular pacing.
- To assess the clinical utility of these scoring systems in a specific patient cohort.
Main Methods:
- Retrospective analysis of ECGs from 43 pacemaker patients undergoing coronary angiography for acute coronary syndrome.
- ECGs were interpreted by two blinded cardiologists.
- STEMI diagnosis confirmed by angiographic and biochemical markers.
Main Results:
- STEMI was diagnosed in 60% of the patients (26/43).
- Selvester's score demonstrated the highest sensitivity (38.5%).
- Sgarbossa's score exhibited the highest specificity (100%).
Conclusions:
- No single score was optimal for diagnosing STEMI in this population.
- Sequential application of Sgarbossa's, Selvester's, and Smith's scores may improve diagnostic accuracy.
- Further research is needed to refine diagnostic strategies for STEMI in pacemaker patients with LBBB.
Background/Purpose:
In patients with right ventricular pacing, the ECG shows a left bundle branch block (LBBB) pattern. There are several criteria to diagnose ST-elevation myocardial infarction (STEMI) in patients with LBBB. The aim of this study was to validate and compare Sgarbossa's with two new scores - Selvester's and Smith's - in this context.
Methods:
We identified pacemaker patients submitted to coronary angiography due to acute coronary syndrome. ECGs were analyzed by 2 blinded cardiologists. STEMI was defined according to angiographic and biochemical criteria. Sensitivity, specificity, positive and negative predictive values were calculated.
Results:
Forty-three patients with ventricular pacing were included for analysis. STEMI was diagnosed in 26 patients (60%). The most sensitive score was Selvester's (38.5%; 95% CI: 20.2-59.4) while the most specific was Sgarbossa's (100%; 95% CI: 80.5-100).
Conclusions:
The sequential application of these scores proved to be clinically useful in the context of STEMI.
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