IAM en presencia de BCRIHH

Dr. Lpez

Un infarto del miocardio consta de tres zonas

tpicas:
1) Isqumica.
2) Lesionada.
3) Muerta.

Sodi-Pallares D, Medrano GA, Bisteni A, Ponce de Len J.

Electrocardiografa clnica: Anlisis deductivo. Francisco Mndez
Cervantes Editor. 1983. Mxico, D.F.

Uso ptimo de
terapias de
reperfusin
coronaria

Se basa

Dx rpido de
IM en
evolucin

Mayora de px
con dolor
torcico
Electrocardiograma
Sgarbossa E. Electrocardiographic diagnosis of evolving acute
myocardial infarction in the presence of left bundle-branch block. The
New England Journal of Medicine. 1996.

Px IAM con
BRIHH

Caractersticas
electrocardiogrficas
enmascaradas

Sgarbossa E. Electrocardiographic diagnosis of evolving acute

myocardial infarction in the presence of left bundle-branch block. The
New England Journal of Medicine. 1996.

Estudio de Sgarbossa y cols.

Frec: 100Hz;
V: 25mm/s;
A: 10 mm/mV.

Grupo
control

Grupo
estudio

DDCD

GUSTO-1

EAC = Angio
BCRIHH

Derivacin
de muestra

IAM = EC
BCRIHH

Sgarbossa E. Electrocardiographic diagnosis of evolving acute

myocardial infarction in the presence of left bundle-branch block. The
New England Journal of Medicine. 1996.

Definicin de bloqueo de rama izquierda

Duracin QRS de al menos 0,12 seg

en presencia de R-S o R-SV.

QS o rS en V1.
Tiempo pico-onda R de al menos 0,06
seg en I, V5 o V6 asociado con
ausencia de Q en mismas
derivaciones.

Sgarbossa E. Electrocardiographic diagnosis of evolving acute

myocardial infarction in the presence of left bundle-branch block. The
New England Journal of Medicine. 1996.

Interpretacin de los electrocardiogramas

Analizados por
1 de 4
investigadores

Desconoca ID
y variables
clnicas

Sgarbossa E. Electrocardiographic diagnosis of evolving acute

myocardial infarction in the presence of left bundle-branch block. The
New England Journal of Medicine. 1996.

Sgarbossa E. Electrocardiographic diagnosis of evolving acute

myocardial infarction in the presence of left bundle-branch block. The
New England Journal of Medicine. 1996.

Resultados
26,003 pacientes
norteamericanos

145 con BRIHH

131 con IAM

confirmado
Sometidos a
criterios de
Sgarbossa
Sgarbossa E. Electrocardiographic diagnosis of evolving acute
myocardial infarction in the presence of left bundle-branch block. The
New England Journal of Medicine. 1996.

131 pacientes
Hallazgo con ms
sensibilidad (>90%)

segmento ST
1mm concordante con
QRS

Sgarbossa E. Electrocardiographic diagnosis of evolving acute

myocardial infarction in the presence of left bundle-branch block. The
New England Journal of Medicine. 1996.

Los cocientes de probabilidad indican

en qu medida un criterio particular
aumentar o disminuir la probabilidad
de infarto.
Sgarbossa E. Electrocardiographic diagnosis of evolving acute
myocardial infarction in the presence of left bundle-branch block. The
New England Journal of Medicine. 1996.

Anlisis
multivariado

Modelo de
regresin
mltiple

Especificidad =
90% >3

Sgarbossa E. Electrocardiographic diagnosis of evolving acute

myocardial infarction in the presence of left bundle-branch block. The
New England Journal of Medicine. 1996.

Sgarbossa E. Electrocardiographic diagnosis of evolving acute

myocardial infarction in the presence of left bundle-branch block. The
New England Journal of Medicine. 1996.

Trazo de prctica