Infarto agudo de miocardio y bloqueo de rama izquierda: utilidad de los criterios de Sgarbossa
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Introducción: En presencia de bloqueo de la rama izquierda, el infarto agudo de miocardio (IAM) es un reto diagnóstico para el médico. Objetivo: Evaluar la utilidad de los criterios de Sgarbossa en el diagnóstico de IAM en pacientes con bloqueo de la rama izquierda mediante una revisión sistemática y metaanálisis. Método: Búsqueda estructurada de la literatura en Medline, Lilacs, Ovid y Embase, desde enero 1996 hasta enero de 2018. Basados en los criterios de inclusión y exclusión, tres revisores seleccionaron los artículos que respondieran la pregunta de investigación. La calidad de los artículos se evaluó con el instrumento QUADAS-2. Resultados: Catorce estudios evaluaron los criterios de Sgarbossa utilizando un puntaje mayor o igual a 3 como corte. En total, fueron 3689 pacientes. La sensibilidad fue de 0,27 (IC95 %: 0,24-0,29; p = 0,0000); especificidad de 0,97 (IC95 %: 0,96-0,98; p = 0,0001) LR(+) de 10,95 (6,28-19,11; p = 0,03) y LR(–) de 0,67 (0,56-0,81; p = 0,0000). Conclusiones: Los criterios de Sgarbossa tienen una alta especificidad para el diagnóstico de IAM con bloqueo de la rama izquierda; pero bajo LR(–) y sensibilidad. Se deben evaluar nuevos algoritmos diagnósticos y validar para la población colombiana.
2. Sgarbossa EB, Pinski SL, Barbagelata A, Underwood DA, Gates KB, Topol EJ, et al. Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block. N Engl J Med. 1996 Feb 22;334(8):481-7.
3. Tabas JA, Rodríguez RM, Seligman HK, Goldschlager NF. Electrocardiographic criteria for detecting acute myocardial infarction in patients with left bundle branch block: A meta-analysis. Ann Emerg Med. 2008;52(4):329-36. https://doi.org/10,1016/j.annemergmed.2007,12.006
4. Dodd KW, Elm KD, Smith SW. Comparison of the QRS complex, ST-segment, and T-wave among patients with left bundle branch block with and without acute myocardial infarction. J Emerg Med. 2016;51(1):1-8.
5. Jain S, Ting HT, Bell M, Bjerke CM, Lennon RJ, Gersh BJ, et al. Utility of left bundle branch block as a diagnostic criterion for acute myocardial infarction. Am J Cardiol. 2011 Apr 15;107(8):1111-6.
6. Kontos MC, McQueen RH, Jesse RL, Tatum JL, Ornato JP. Can myocardial infarction be rapidly identified in emergency department patients who have left bundle-branch block? Ann Emerg Med. 2001 May;37(5):431-8.
7. Shlipak MG, Lyons WL, Go AS, Chou TM, Evans GT, Browner WS. Should the electrocardiogram be used to guide therapy for patients with left bundle-branch block and suspected myocardial infarction? JAMA. 1999 Feb;281(8):714.
8. Edhouse JA, Sakr M, Angus J, Morris FP. Suspected myocardial infarction and left bundle branch block: electrocardiographic indicators of acute ischaemia. J Accid Emerg Med. 1999;16(5):331-5.
9. Eriksson P, Gunnarsson G, Dellborg M. Diagnosis of acute myocardial infarction in patients with chronic left bundle-branch block. Standard 12-lead ECG compared to dynamic vectorcardiography. Scand Cardiovasc J. 1999;33(1):17-22.
10. Di Marco A, Anguera I, Rodríguez M, Sionis A, Bayes-Genis A, Rodríguez J, et al. Assessment of smith algorithms for the diagnosis of acute myocardial infarction in the presence of left bundle branch block. Rev Esp Cardiol. 2017 Jul;70(7):559-66.
11. Meyers HP, Limkakeng AT, Jaffa EJ, Patel A, Theiling BJ, Rezaie SR, et al. Validation of the modified Sgarbossa criteria for acute coronary occlusion in the setting of left bundle branch block: A retrospective case-control study. Am Heart J. 2015 Dec;170(6):1255-64.
12. Smith SW, Dodd KW, Henry TD, Dvorak DM, Pearce LA. Diagnosis of ST-elevation myocardial infarction in the presence of left bundle branch block with the ST-elevation to S-wave ratio in a modified Sgarbossa rule. Ann Emerg Med. 2012 Dec;60(6):766-76.
13. Wong CK, French JK, Aylward PEG, Stewart RAH, Gao W, Armstrong PW, et al. Patients with prolonged ischemic chest pain and presumed-new left bundle branch block have heterogeneous outcomes depending on the presence of ST-segment changes. J Am Coll Cardiol. 2005;46(1):29-38.
14. Mehta N, Huang HD, Bandeali S, Wilson JM, Birnbaum Y. Prevalence of acute myocardial infarction in patients with presumably new left bundle-branch block. J Electrocardiol. 2012 Jul;45(4):361-7.
15. Al-Faleh H, Fu Y, Wagner G, Goodman S, Sgarbossa E, Granger C, et al. Unraveling the spectrum of left bundle branch block in acute myocardial infarction: Insights from the Assessment of the Safety and Efficacy of a New Thrombolytic (ASSENT 2 and 3) trials. Am Heart J. 2006 Jan;151(1):10-5.
16. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2018 Jan;39(2):119-77.
17. Gregg RE, Helfenbein ED, Babaeizadeh S. New ST-segment elevation myocardial infarction criteria for left bundle branch block based on QRS area. J Electrocardiol. 2013;46(6):528-34.
18. Gula LJ, Dick A, Massel D. Diagnosing acute myocardial infarction in the setting of left bundle branch block: prevalence and observer variability from a large community study. Coron Artery Dis. 2003 Aug;14(5):387-93.
19. Li SF, Walden PL, Marcilla O, Gallagher EJ. Electrocardiographic diagnosis of myocardial infarction in patients with left bundle branch block. Ann Emerg Med. 2000;36(6):561-5.
20. Sionis A, Bayes-genis A, Marco A Di, Anguera I, Rodrı M, Ariza-sole A, et al. Assessment of smith algorithms for the diagnosis of acute myocardial infarction in the presence of left bundle branch block. 2016;70(7):559-66.
21. Maloy KR, Bhat R, Davis J, Reed K, Morrissey R. Sgarbossa criteria are highly specific for acute myocardial infarction with pacemakers. West J Emerg Med. 2010;11(4):354-7.
22. Gunnarsson G, Eriksson P, Dellborg M. ECG criteria in diagnosis of acute myocardial infarction in the presence of left bundle branch block. Int J Cardiol. 2001 Apr;78(2):167-74.
23. Maynard SJ, Menown IB, Manoharan G, Allen J, Mc CAJ, Adgey AA. Body surface mapping improves early diagnosis of acute myocardial infarction in patients with chest pain and left bundle branch block. Heart. 2003;89(9):998-1002.