Diagnosing Value Of Barcelona Rules In Patients With Acute Myocardial Infarction Complicated Complete Left Bundle Branch Block

Backgroundscute ST-segment elevation myocardial infarction(STEMI)is a severe type of coronary heart disease(CHD).In different illness stages,its electrocardiogram(ECG)has obvious changes,such as,injured ST-segment elevation,ischemic T wave,formation of necrotic Q wave and so on and it is easy to diagnose STEMI with typical clinical performance and ECG.However,when complicating complete left bundle branch block(CLBBB),both change initial vector quantity and secondary STT can mask primary ST-T modulation caused by conditions that alter the gradient of ventricular repolarization such as myocardial ischemia or injury,which makes above ECG manifestation untypical,so may produce a delay of diagnosis and therapy.The presence of CLBBB in patients with coronary ischemic symptoms has traditionally been considered an ECG equivalent to ST-segment elevation,so the 2017 European Society of Cardiology guidelines still recommend emergent reperfusion in such cases.However,with more clinical study carried out,increasing evidence suggests CLBBB is a major cause of false activation of the primary percutaneous coronary intervention(pPCI)protocol.According to an investigation,among patients with CLBBB referred for pPCI,only 37%actually had an AMI.Unfortunately,patients with AMI complicated CLBBB suffer from high mortality,therefore,early reperfusion therapy play important role in prognosis.This requires diagnostic means with high sensitivity and specificity.From 1953,a series of electrogram algorithms were mentioned by cardiologists to diagnose AMI with CLBBB,but have low sensitivity or specificity,complicated contents and difficult memory,therefore there is no uniform algorithm.So,after observation and validation,getting a valuable algorithm is a urgent matter in clinical work.In 2020,Barcelona algorithm was mentioned by Marco et al,and its sensitivity and specificity in diagnosing AMI complicated CLBBB are 93%-95%and 89%-94%,respectively.Besides,the algorithm is simple and easy to memorize,because it is referred to just now,lack of research.ObjectiveTo validate the diagnosis value of Barcelona algorithm in patients with AMI and CLBBB.MethodsA retrospective study was performed to analyze the clinical data of 108 patients,who were from 3 hospitals in ZhengZhou.These patients were divided into 2 groups,validation group(patients with AMI and CLBBB,n=47)and control group(patients with CLBBB,n=61).The general clinical indicator of each patient were recorded at admission,such as sex,age,history and so on.All patients had the examination of blood routine examination,serum electrolytes,kidney and liver function,Nterminal B-type natriuretic peptide(NT-proBNP),blood-fat,glucose,cadiac troponin,plus 12-lead electrocardiogram and transthoracic echocardiography(TTE).According to their symptom,sign,history and laboratory test,after assessment,some patients underwent emergent coronary arteriography(CAG)and necessary primary percutaneous coronary intervention(pPCI).Some patients underwent coronary angiography with computed tomography(CTA)and 3.0T cardiac magnetic resonance(CMR).Then calculated sensitivity,specificity,positive predictive value,negative predictive value applying to Cabrera sign,Chapman sign,Sgarbossa rule,Smith rule,Barcelona algorithm.Results1.The diagnostic sensitivity and specificity of Cabrare sign are 34.04%and 85.25%.The positive predictive value and negative predivtive value are 59.26%and 61.73%.The area under receiver operating characteristic curve is 0.644.2.The diagnostic sensitivity and specificity of Chapman sign are 27.66%and 93.44%.The positive predictive value and negative predivtive value are 76.47%and 62.64%.The area under receiver operating characteristic curve is 0.606.3.The diagnostic sensitivity and specificity of Sgarbossa rule are 19.15%and 96.60%.The positive predictive value and negative predivtive value are 81.81%and 62.64%.The area under receiver operating characteristic curve is 0.579.4.The diagnostic sensitivity and specificity of Smith rule are 27.70%and 95.10%.The positive predictive value and negative predivtive value are 81.25%and 63.04%.The area under receiver operating characteristic curve is 0.614.5.The diagnostic sensitivity and specificity of Barcelona algorithm are 68.00%and 90.20%.The positive predictive value and negative predivtive value are 84.21%and 78.57%.The area under receiver operating characteristic curve is 0.791.Conclusions1.Barcelona rule has the higher sensitivity and specificity in diagnosing AMI complicated CLBBB.2.Comparing with Cabrera sign,Chapman sign,Sgarbossa rules,Smith rule,Barcelona algorithm has better clinical value.