title: ECG evaluation in patients with pacemaker and suspected acute coronary syndrome: Which score should we apply?
abstract: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  The sequential application of these scores proved to be clinically useful in the context of STEMI.
authors.affiliation: Cardiology Department, Hospital de Santa Cruz, Avenida Professor Doutor Reinaldo dos Santos, 2790-134 Carnaxide, Lisbon, Portugal. Electronic address: pnunofreitas@gmail.com.
authors.forename: Pedro
authors.initials: P
authors.lastname: Freitas
authors.affiliation: Cardiology Department, Hospital de Santa Cruz, Avenida Professor Doutor Reinaldo dos Santos, 2790-134 Carnaxide, Lisbon, Portugal.
authors.forename: Miguel Borges
authors.initials: MB
authors.lastname: Santos
authors.affiliation: Cardiology Department, Hospital de Santa Cruz, Avenida Professor Doutor Reinaldo dos Santos, 2790-134 Carnaxide, Lisbon, Portugal.
authors.forename: Mariana
authors.initials: M
authors.lastname: Faria
authors.affiliation: Cardiology Department, Hospital de Santa Cruz, Avenida Professor Doutor Reinaldo dos Santos, 2790-134 Carnaxide, Lisbon, Portugal.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Rodrigues
authors.affiliation: Cardiology Department, Hospital de Santa Cruz, Avenida Professor Doutor Reinaldo dos Santos, 2790-134 Carnaxide, Lisbon, Portugal.
authors.forename: Nélson
authors.initials: N
authors.lastname: Vale
authors.affiliation: Cardiology Department, Hospital de Santa Cruz, Avenida Professor Doutor Reinaldo dos Santos, 2790-134 Carnaxide, Lisbon, Portugal.
authors.forename: Rui Campante
authors.initials: RC
authors.lastname: Teles
authors.affiliation: Cardiology Department, Hospital de Santa Cruz, Avenida Professor Doutor Reinaldo dos Santos, 2790-134 Carnaxide, Lisbon, Portugal.
authors.forename: Manuel
authors.initials: M
authors.lastname: Almeida
authors.affiliation: Cardiology Department, Hospital de Santa Cruz, Avenida Professor Doutor Reinaldo dos Santos, 2790-134 Carnaxide, Lisbon, Portugal.
authors.forename: Miguel
authors.initials: M
authors.lastname: Mendes
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000628:therapy; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D003937:Diagnosis, Differential; D004562:Electrocardiography / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000628:therapy; D010138:Pacemaker, Artificial; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: Artificial; Cardiac pacemaker; Coronary occlusion; Electrocardiography; Myocardial infarction