title: Validation of the modified Sgarbossa criteria for acute coronary occlusion in the setting of left bundle branch block: A retrospective case-control study.
abstract: BACKGROUND
  The modified Sgarbossa criteria were proposed in a derivation study to be superior to the original criteria for diagnosing acute coronary occlusion (ACO) in left bundle branch block (LBBB). The new rule replaces the third criterion (5 mm of excessively discordant ST elevation [STE]) with a proportion (at least 1 mm STE and STE/S wave ≤-0.25). We sought to validate the modified criteria.
  
  
  METHODS
  This retrospective case-control study was performed by chart review in 2 tertiary care center emergency departments (EDs) and 1 regional referral center. A billing database was used at 1 site to identify all ED patients with LBBB and ischemic symptoms between May 2009 and June 2012. In addition, all 3 sites identified LBBB ACO patients who underwent emergent catheterization. We measured QRS amplitude and J-point deviation in all leads, blinded to outcomes. Acute coronary occlusion was determined by angiographic findings and cardiac biomarker levels, which were collected blinded to electrocardiograms. Diagnostic statistics of each rule were calculated and compared using McNemar's test.
  
  
  RESULTS
  Our consecutive cohort search identified 258 patients: 9 had ACO, and 249 were controls. Among the 3 sites, an additional 36 cases of ACO were identified, for a total of 45 ACO cases and 249 controls. The modified criteria were significantly more sensitive than the original weighted criteria (80% vs 49%, P < .001) and unweighted criteria (80% vs 56%, P < .001). Specificity of the modified criteria was not statistically different from the original weighted criteria (99% vs 100%, P = .5) but was significantly greater than the original unweighted criteria (99% vs 94%, P = .004).
  
  
  CONCLUSIONS
  The modified Sgarbossa criteria were superior to the original criteria for identifying ACO in LBBB.
authors.affiliation: Duke University School of Medicine, Durham, NC. Electronic address: hpm7@duke.edu.
authors.forename: H Pendell
authors.initials: HP
authors.lastname: Meyers
authors.affiliation: Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Alexander T
authors.initials: AT
authors.lastname: Limkakeng
authors.affiliation: Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Elias J
authors.initials: EJ
authors.lastname: Jaffa
authors.affiliation: Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: Anjni
authors.initials: A
authors.lastname: Patel
authors.affiliation: Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: B Jason
authors.initials: BJ
authors.lastname: Theiling
authors.affiliation: Department of Emergency Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX.
authors.forename: Salim R
authors.initials: SR
authors.lastname: Rezaie
authors.affiliation: Department of Emergency Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX.
authors.forename: Todd
authors.initials: T
authors.lastname: Stewart
authors.affiliation: Department of Emergency Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX.
authors.forename: Cassandra
authors.initials: C
authors.lastname: Zhuang
authors.affiliation: Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN.
authors.forename: Vijaya K
authors.initials: VK
authors.lastname: Pera
authors.affiliation: Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN; Department of Emergency Medicine, University of Minnesota.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Smith
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D002037:Bundle-Branch Block / Q000150:complications / Q000175:diagnosis; D016022:Case-Control Studies; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000150:complications*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity