Di Marco, AndreaRodriguez, MarcosCinca, JuanBayés Genís, AntoniOrtiz Pérez, José TomásAriza Solé, AlbertSánchez Salado, Jose CarlosSionis, AlessandroRodriguez, JanyToledano, BeatrizCodina, PauSolé González, EduardMasotti, MonicaGómez Hospital, Joan AntoniCequier Fillat, Àngel R.Anguera Camós, Ignasi2021-02-222021-02-222020-07-21https://hdl.handle.net/2445/174104Background Current electrocardiographic algorithms lack sensitivity to diagnose acute myocardial infarction (AMI) in the presence of left bundle branch block. Methods and Results A multicenter retrospective cohort study including consecutive patients with suspected AMI and left bundle branch block, referred for primary percutaneous coronary intervention between 2009 and 2018. Pre-2015 patients formed the derivation cohort (n=163, 61 with AMI); patients between 2015 and 2018 formed the validation cohort (n=107, 40 with AMI). A control group of patients without suspected AMI was also studied (n=214). Different electrocardiographic criteria were tested. A total of 484 patients were studied. A new electrocardiographic algorithm (BARCELONA algorithm) was derived and validated. The algorithm is positive in the presence of ST deviation ≥1 mm (0.1 mV) concordant with QRS polarity, in any lead, or ST deviation ≥1 mm (0.1 mV) discordant with the QRS, in leads with max (R|S) voltage (the voltage of the largest deflection of the QRS, ie, R or S wave) ≤6 mm (0.6 mV). In both the derivation and the validation cohort, the BARCELONA algorithm achieved the highest sensitivity (93%-95%), negative predictive value (96%-97%), efficiency (91%-94%) and area under the receiver operating characteristic curve (0.92-0.93), significantly higher than previous electrocardiographic rules (P<0.01); the specificity was good in both groups (89%-94%) as well as the control group (90%). Conclusions In patients with left bundle branch block referred for primary percutaneous coronary intervention, the BARCELONA algorithm was specific and highly sensitive for the diagnosis of AMI, leading to a diagnostic accuracy comparable to that obtained by ECG in patients without left bundle branch block.22 p.application/pdfengcc by-nc-nd (c) Di Marco, Andrea et al., 2020http://creativecommons.org/licenses/by-nc-nd/3.0/es/ElectrocardiografiaInfart de miocardiMyocardial infarctionElectrocardiographyinfo:eu-repo/semantics/article2021-02-19info:eu-repo/semantics/openAccess32627643