title: [Diagnostic value of left bundle branch block in patients with acute myocardial infarction. A prospective analysis].
abstract: BACKGROUND
  In contemporary practice with early catheterization in most patients with suspected acute myocardial infarction, the clinical utility of new or presumably new left bundle branch block (LBBB) as a diagnostic criterion equivalent to ST-segment elevation is not well established. This study therefore aimed to determine the predictive value of LBBB for the diagnosis of acute transmural myocardial infarction (or ST-segment elevation myocardial infarction, STEMI).
  
  
  METHODS
  Between November 2006 and December 2011, 1,139 consecutive patients presenting to the heart center of the University of Cologne with suspected STEMI were examined. Of these patients, 935 presented with ST elevation, 72 with LBBB, and 132 had neither of these ECG changes. The diagnosis was confirmed with immediate coronary angiography.
  
  
  RESULTS
  Compared with ST-segment elevation, LBBB was associated with a higher prevalence of cardiovascular risk factors and end-organ damage, and more patients with LBBB presented with pulmonary edema or cardiogenic shock (Killip III/IV). STEMI was confirmed in 58.3 % of patients with LBBB and in 86.4 % with ST-segment elevation. The sensitivity (0.38 [0.29-0.46]; odds ratio: 1.24) and specificity (0.67 [0.58-0.77]) of LBBB for the prediction of STEMI were low. However, the additional assessment of troponin T (> 0.1 µg/l) increased the predictive value of LBBB significantly. After adjusting for age and gender, no difference in mortality was found between the groups.
  
  
  CONCLUSIONS
  LBBB with acute chest pain characterizes a cohort of patients with high morbidity and mortality. For the triage of these patients at first contact, additional criteria should be evaluated, which could increase the specificity of LBBB for the diagnosis of STEMI.
authors.affiliation: Klinik für Kardiologie, Pneumologie, Angiologie und Internistische Intensivmedizin, Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
authors.forename: Christian
authors.initials: C
authors.lastname: Wegmann
authors.affiliation: Klinik für Kardiologie, Pneumologie, Angiologie und Internistische Intensivmedizin, Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
authors.forename: Roman
authors.initials: R
authors.lastname: Pfister
authors.affiliation: Klinik für Kardiologie, Pneumologie, Angiologie und Internistische Intensivmedizin, Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
authors.forename: Steffen
authors.initials: S
authors.lastname: Scholz
authors.affiliation: Klinik für Kardiologie, Pneumologie, Angiologie und Internistische Intensivmedizin, Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
authors.forename: Anne
authors.initials: A
authors.lastname: Markhof
authors.affiliation: Klinik für Kardiologie, Pneumologie, Angiologie und Internistische Intensivmedizin, Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Wanke
authors.affiliation: Institut für Medizinische Statistik, Informatik und Epidemiologie, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Kuhr
authors.affiliation: Klinik für Kardiologie, Pneumologie, Angiologie und Internistische Intensivmedizin, Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
authors.forename: Tanja
authors.initials: T
authors.lastname: Rudolph
authors.affiliation: Klinik für Kardiologie, Pneumologie, Angiologie und Internistische Intensivmedizin, Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Baldus
authors.affiliation: Klinik für Kardiologie, Pneumologie, Angiologie und Internistische Intensivmedizin, Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland. hannes.reuter@uk-koeln.de.
authors.forename: Hannes
authors.initials: H
authors.lastname: Reuter
mesh_terms: D056586:Acute Chest Syndrome / Q000175:diagnosis / Q000453:epidemiology*; D000368:Aged; D002037:Bundle-Branch Block / Q000175:diagnosis* / Q000401:mortality*; D015897:Comorbidity; D004562:Electrocardiography / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality*; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D015996:Survival Rate
keywords: Cardiac catheterization; Chest pain, acute; Myocardial infarction care; Predictive value; Structured care