Should the electrocardiogram be used to guide therapy for patients with left bundle-branch block and suspected myocardial infarction?

Michael G. Shlipak, William L Lyons, Alan S. Go, Tony M. Chou, G. Thomas Evans, Warren S. Browner

Research output: Contribution to journalArticle

74 Citations (Scopus)

Abstract

Context: Recently, an algorithm based on the electrocardiogram (ECG) was reported to predict myocardial infarction (MI) in patients with left bundle- branch block (LBBB), but the clinical impact of this testing strategy is unknown. Objective: To determine the diagnostic test characteristics and clinical utility of this ECG algorithm for patients with suspected MI. Design: Retrospective cohort study to which an algorithm was applied, followed by decision analysis regarding thrombolysis made with or without the algorithm. Setting: University emergency department, 1994 through 1997. Patients Eighty-three patients with LBBB who presented 103 times with symptoms suggestive of MI. Main Outcome Measures: Myocardial infarction determined by serial cardiac enzyme analyses and stroke-free survival. Results: Of 9 ECG findings assessed, none effectively distinguished the 30% of patients with MI from those with other diagnoses. The ECG algorithm indicated positive findings in only 3% of presentations and had a sensitivity of 10% (95% confidence interval, 2%-26%). The decision analysis showed that among 1000 patients with LBBB and chest pain, 929 would survive without major stroke if all received thrombolysis compared with 918 if the ECG algorithm was used as a screening test. Conclusions: The ECG is a poor predictor of MI in a community-based cohort of patients with LBBB and acute cardiopulmonary symptoms. Acute thrombolytic therapy should be considered for all patients with LBBB who have symptoms consistent with MI.

Original languageEnglish (US)
Pages (from-to)714-719
Number of pages6
JournalJournal of the American Medical Association
Volume281
Issue number8
DOIs
StatePublished - Feb 24 1999

Fingerprint

Bundle-Branch Block
Electrocardiography
Myocardial Infarction
Decision Support Techniques
Therapeutics
Stroke
Thrombolytic Therapy
Chest Pain
Routine Diagnostic Tests
Hospital Emergency Service
Cohort Studies
Retrospective Studies
Outcome Assessment (Health Care)
Confidence Intervals
Survival
Enzymes

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Should the electrocardiogram be used to guide therapy for patients with left bundle-branch block and suspected myocardial infarction? / Shlipak, Michael G.; Lyons, William L; Go, Alan S.; Chou, Tony M.; Evans, G. Thomas; Browner, Warren S.

In: Journal of the American Medical Association, Vol. 281, No. 8, 24.02.1999, p. 714-719.

Research output: Contribution to journalArticle

Shlipak, Michael G. ; Lyons, William L ; Go, Alan S. ; Chou, Tony M. ; Evans, G. Thomas ; Browner, Warren S. / Should the electrocardiogram be used to guide therapy for patients with left bundle-branch block and suspected myocardial infarction?. In: Journal of the American Medical Association. 1999 ; Vol. 281, No. 8. pp. 714-719.
@article{8c084e538d304a3a91072111e8b6a2e1,
title = "Should the electrocardiogram be used to guide therapy for patients with left bundle-branch block and suspected myocardial infarction?",
abstract = "Context: Recently, an algorithm based on the electrocardiogram (ECG) was reported to predict myocardial infarction (MI) in patients with left bundle- branch block (LBBB), but the clinical impact of this testing strategy is unknown. Objective: To determine the diagnostic test characteristics and clinical utility of this ECG algorithm for patients with suspected MI. Design: Retrospective cohort study to which an algorithm was applied, followed by decision analysis regarding thrombolysis made with or without the algorithm. Setting: University emergency department, 1994 through 1997. Patients Eighty-three patients with LBBB who presented 103 times with symptoms suggestive of MI. Main Outcome Measures: Myocardial infarction determined by serial cardiac enzyme analyses and stroke-free survival. Results: Of 9 ECG findings assessed, none effectively distinguished the 30{\%} of patients with MI from those with other diagnoses. The ECG algorithm indicated positive findings in only 3{\%} of presentations and had a sensitivity of 10{\%} (95{\%} confidence interval, 2{\%}-26{\%}). The decision analysis showed that among 1000 patients with LBBB and chest pain, 929 would survive without major stroke if all received thrombolysis compared with 918 if the ECG algorithm was used as a screening test. Conclusions: The ECG is a poor predictor of MI in a community-based cohort of patients with LBBB and acute cardiopulmonary symptoms. Acute thrombolytic therapy should be considered for all patients with LBBB who have symptoms consistent with MI.",
author = "Shlipak, {Michael G.} and Lyons, {William L} and Go, {Alan S.} and Chou, {Tony M.} and Evans, {G. Thomas} and Browner, {Warren S.}",
year = "1999",
month = "2",
day = "24",
doi = "10.1001/jama.281.8.714",
language = "English (US)",
volume = "281",
pages = "714--719",
journal = "JAMA - Journal of the American Medical Association",
issn = "0002-9955",
publisher = "American Medical Association",
number = "8",

}

TY - JOUR

T1 - Should the electrocardiogram be used to guide therapy for patients with left bundle-branch block and suspected myocardial infarction?

AU - Shlipak, Michael G.

AU - Lyons, William L

AU - Go, Alan S.

AU - Chou, Tony M.

AU - Evans, G. Thomas

AU - Browner, Warren S.

PY - 1999/2/24

Y1 - 1999/2/24

N2 - Context: Recently, an algorithm based on the electrocardiogram (ECG) was reported to predict myocardial infarction (MI) in patients with left bundle- branch block (LBBB), but the clinical impact of this testing strategy is unknown. Objective: To determine the diagnostic test characteristics and clinical utility of this ECG algorithm for patients with suspected MI. Design: Retrospective cohort study to which an algorithm was applied, followed by decision analysis regarding thrombolysis made with or without the algorithm. Setting: University emergency department, 1994 through 1997. Patients Eighty-three patients with LBBB who presented 103 times with symptoms suggestive of MI. Main Outcome Measures: Myocardial infarction determined by serial cardiac enzyme analyses and stroke-free survival. Results: Of 9 ECG findings assessed, none effectively distinguished the 30% of patients with MI from those with other diagnoses. The ECG algorithm indicated positive findings in only 3% of presentations and had a sensitivity of 10% (95% confidence interval, 2%-26%). The decision analysis showed that among 1000 patients with LBBB and chest pain, 929 would survive without major stroke if all received thrombolysis compared with 918 if the ECG algorithm was used as a screening test. Conclusions: The ECG is a poor predictor of MI in a community-based cohort of patients with LBBB and acute cardiopulmonary symptoms. Acute thrombolytic therapy should be considered for all patients with LBBB who have symptoms consistent with MI.

AB - Context: Recently, an algorithm based on the electrocardiogram (ECG) was reported to predict myocardial infarction (MI) in patients with left bundle- branch block (LBBB), but the clinical impact of this testing strategy is unknown. Objective: To determine the diagnostic test characteristics and clinical utility of this ECG algorithm for patients with suspected MI. Design: Retrospective cohort study to which an algorithm was applied, followed by decision analysis regarding thrombolysis made with or without the algorithm. Setting: University emergency department, 1994 through 1997. Patients Eighty-three patients with LBBB who presented 103 times with symptoms suggestive of MI. Main Outcome Measures: Myocardial infarction determined by serial cardiac enzyme analyses and stroke-free survival. Results: Of 9 ECG findings assessed, none effectively distinguished the 30% of patients with MI from those with other diagnoses. The ECG algorithm indicated positive findings in only 3% of presentations and had a sensitivity of 10% (95% confidence interval, 2%-26%). The decision analysis showed that among 1000 patients with LBBB and chest pain, 929 would survive without major stroke if all received thrombolysis compared with 918 if the ECG algorithm was used as a screening test. Conclusions: The ECG is a poor predictor of MI in a community-based cohort of patients with LBBB and acute cardiopulmonary symptoms. Acute thrombolytic therapy should be considered for all patients with LBBB who have symptoms consistent with MI.

UR - http://www.scopus.com/inward/record.url?scp=0033599262&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033599262&partnerID=8YFLogxK

U2 - 10.1001/jama.281.8.714

DO - 10.1001/jama.281.8.714

M3 - Article

VL - 281

SP - 714

EP - 719

JO - JAMA - Journal of the American Medical Association

JF - JAMA - Journal of the American Medical Association

SN - 0002-9955

IS - 8

ER -