{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T02:30:29Z","timestamp":1791599429190,"version":"4.3.4"},"reference-count":32,"publisher":"BMJ","issue":"20","funder":[{"DOI":"10.13039\/501100001078","name":"Queensland Emergency Medicine Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001078","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001711","name":"Schweizerischer Nationalfonds zur F\u00f6rderung der Wissenschaftlichen Forschung","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001711","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004362","name":"Schweizerische Herzstiftung","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004362","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Heart"],"accepted":{"date-parts":[[2019,5,8]]},"published-print":{"date-parts":[[2019,10]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>Patients with suspected acute myocardial infarction (AMI) in the setting of left bundle branch block (LBBB) present an important diagnostic and therapeutic challenge to the clinician.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We prospectively evaluated the incidence of AMI and diagnostic performance of specific ECG and high-sensitivity cardiac troponin (hs-cTn) criteria in patients presenting with chest discomfort to 26 emergency departments in three international, prospective, diagnostic studies. The final diagnosis of AMI was centrally adjudicated by two independent cardiologists according to the universal definition of myocardial infarction.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 8830 patients, LBBB was present in 247 (2.8%). AMI was the final diagnosis in 30% of patients with LBBB, with similar incidence in those with known LBBB versus those with presumably new LBBB (29% vs 35%, p=0.42). ECG criteria had low sensitivity (1%\u201312%) but high specificity (95%\u2013100%) for AMI. The diagnostic accuracy as quantified by the receiver operating characteristics (ROC) curve of hs-cTnT and hs-cTnI concentrations at presentation (area under the ROC curve (AUC) 0.91, 95%\u2009CI 0.85 to 0.96 and AUC 0.89, 95%\u2009CI 0.83 to 0.95), as well as that of their 0\/1-hour and 0\/2-hour changes, was very high. A diagnostic algorithm combining ECG criteria with hs-cTnT\/I concentrations and their absolute changes at 1\u2009hour or 2\u2009hours derived in cohort 1 (45 of 45(100%) patients with AMI correctly identified) showed high efficacy and accuracy when externally validated in cohorts 2 and 3 (28 of 29 patients, 97%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Most patients presenting with suspected AMI and LBBB will be found to have diagnoses other than AMI. Combining ECG criteria with hs-cTnT\/I testing at 0\/1 hour or 0\/2\u2009hours allows early and accurate diagnosis of AMI in LBBB.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial registration number<\/jats:title>\n                  <jats:p>APACE: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"NCT00470587\" ext-link-type=\"clintrialgov\" specific-use=\"clinicaltrial results\">NCT00470587<\/jats:ext-link>; ADAPT: ACTRN12611001069943; TRAPID-AMI: RD001107;Results.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/heartjnl-2018-314673","type":"journal-article","created":{"date-parts":[[2019,5,29]],"date-time":"2019-05-29T17:25:23Z","timestamp":1559150723000},"page":"1559-1567","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":38,"title":["Diagnosis of acute myocardial infarction in the presence of left bundle branch block"],"prefix":"10.1136","volume":"105","clinical-trial-number":[{"clinical-trial-number":"nct00470587","registry":"10.18810\/clinical-trials-gov","type":"results"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2173-5738","authenticated-orcid":false,"given":"Thomas","family":"Nestelberger","sequence":"first","affiliation":[{"name":"Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6611-8229","authenticated-orcid":false,"given":"Louise","family":"Cullen","sequence":"additional","affiliation":[{"name":"Emergency Department, Royal Brisbane and Women\u2019s Hospital, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bertil","family":"Lindahl","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital Uppsala, Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Reichlin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaimi H","family":"Greenslade","sequence":"additional","affiliation":[{"name":"Emergency Department, Royal Brisbane and Women\u2019s Hospital, Brisbane, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evangelos","family":"Giannitsis","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Universitaetsklinikum Heidelberg, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Christ","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Luzerner Kantonsspital, Luzern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beata","family":"Morawiec","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital, Zabrze, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oscar","family":"Miro","sequence":"additional","affiliation":[{"name":"Department of Emergency Department, Hospital Clinic, Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco Javier","family":"Mart\u00edn-S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Emergency Department, Hospital San Carlos de Madrid, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Desiree Nadine","family":"Wussler","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, 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