Sgarbossa Criteria are Highly Specific for Acute Myocardial Infarction with Pacemakers
Kevin R Maloy, Rahul Bhat, Jonathan Davis, Kevin Reed, Richard Morrissey, Kevin R Maloy, Rahul Bhat, Jonathan Davis, Kevin Reed, Richard Morrissey
Abstract
Objective: In 1996 Sgarbossa reviewed 17 ventricular-paced electrocardiograms (ECGs) in acute myocardial infarction (AMI) for signs of ischemia. Several characteristics of the paced ECG were predictive of AMI. We sought to evaluate the criteria in ventricular-paced ECGs in an emergency department (ED) cohort.
Methods: Ventricular-paced ECGs in patients with elevated cardiac markers within 12 hours of the ED ECG and a diagnosis of AMI were identified retrospectively (n=57) and compared with a control group of patients with ventricular-paced ECGs and negative cardiac markers (n=99). A blinded board certified cardiologist reviewed all ECGs for Sgarbossa criteria. This study was approved by the institutional review board.
Results: Application of Sgarbossa's criteria to the paced ECGs revealed the following: The sensitivity of "ST-segment elevation of 1 mm concordant with the QRS complex" was unable to be calculated as no ECG fit this criterion;For "ST-segment depression of 1 mm in lead V1, V2, or V3," the sensitivity was 19% (95% CI 11-31%), specificity 81% (95% CI 72-87%), with a likelihood ratio of 1.06 (0.63-1.64);For "ST-segment elevation >5mm discordant with the QRS complex," the sensitivity was 10% (95% CI 5-21%), specificity 99% (95% CI 93-99%), with a likelihood ratio of 5.2 (1.3 - 21).
Conclusion: In our review of ventricular-paced ECGs, the most clinically useful Sgarbossa criterion in identifying AMI was ST-segment elevation >5mm discordant with the QRS complex. This characteristic may prove helpful in identifying patients who may ultimately benefit from early aggressive AMI treatment strategies.
References
- Rathore SS, Weinfurt KP, Gersh BJ. Treatment of patients with myocardial infarction who present with a paced rhythm. Ann Intern Med. 2001;134:644–51.
- Madias JE. The nonspecificity of ST-segment elevation >or=5.0 mm in V1–V3 in the diagnosis of acute myocardial infarction in the presence of ventricular-paced rhythm. J Electrocardiol. 2004;37:135–9.
- Ufberg J, Harrigan RA, Wittenberg AJ. Acute myocardial infarction complicated by a ventricular-paced rhythm. J Emerg Med. 2004;27:81–3.
- Harper RJ, Brady WJ, Perron AD, et al. The paced electrocardiogram: issues for the emergency physician. Am J Emerg Med. 2001;19:551–60.
- Kozlowski FH, Brady WJ. The electrocardiographic diagnosis of acute myocardial infarction in patients with ventricular-paced rhythms. Acad Emerg Med. 1998;5:52–7.
- Brady WJ. Cases in electrocardiography. Am J Emerg Med. 1998;16:85–6.
- Rosner MH, Brady WJ. The electrocardiographic diagnosis of acute myocardial infarction in patients with ventricular-paced rhythms. Am J Emerg Med. 1999;17:182–5.
- Sgarbossa EB, Pinski SL, Gates KB, et al. Early electrocardiographic diagnosis of acute myocardial infarction in the presence of ventricular-paced rhythm. GUSTO-I investigators. Am J Cardiol. 1996;77:423–4.
- Jagoda AS, Decker WW, Edlow JA, et al. Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients with Non–ST-Segment Elevation Acute Coronary Syndromes. Ann Emerg Med. 2006;48:270–301.
- R Development Core Team . R: A language and environment for statistical computing. Vienna, Austria: 2008. Version 2.7.2.
- Brasil P. DiagnosisMed: Diagnostic test accuracy evaluation for medical professionals. Vienna, Austria: 2008. Version 0.0.2.
- Kontos MC, Roberts BD, Tatum JL, et al. Mortality based on the presenting electrocardiogram in patients with myocardial infarction in the troponin era. AJEM. 2009;27:146–152.
- Nunn CM, O’Neill WW, Rothbaum D. Long term outcome after primary angioplasty: report from the Primary Angioplasty in Myocardial Infarction (PAMI-I) trial. J Am Coll Cardiol. 1999;33:640–6.
- Rathore SS, Gersh BJ, Weinfurt KP. The role of reperfusion therapy in paced patients with acute myocardial infarction. Am Heart J. 2001;142:516–9.
Source: PubMed