The current electrocardiographic algorithms lack sensitivity to diagnose acute myocardial infarction (AMI) in the presence of the left bundle branch block. This retrospective, multicenter cohort study, involved consecutive patients with left bundle branch block and suspected AMI, were referred for primary percutaneous coronary intervention between the years 2009 to 2018. Different types of electrocardiographic criteria were tested and evaluated.
A total of 484 patients were studied. In patients with left bundle branch block referred for primary percutaneous coronary intervention, the BARCELONA algorithm was highly sensitive and specific for AMI diagnosis, leading to greater accuracy as far as diagnostics are considered. In two cohorts of patients with LBBB referred for pPCI, we validated and identified the new ECG algorithm BARCELONA based on the presence of concordant ST deviation ≥1 mm (0.1 mV) in any ECG lead and discordant ST deviation ≥1 mm (0.1 mV) in leads with max (R|S) voltage ≤6 mm (0.6 mV).
This algorithm significantly improved AMI’s diagnosis compared with previous ECG rules, achieving a diagnostic performance for AMI similar to that of ECG in patients without LBBB. The algorithm’s high specificity was confirmed in a large and heterogeneous control group of patients without suspected AMI.