Electrocardiogram (ECG) Diagnosis for Acute Myocardial Infarction in Patients with Bundle Branch Block

Dr Ngai-Yin Chan (Hong Kong)


New or presumably new LBBB should not be considered diagnostic for AMI in isolation while it should be treated as STEMI if there is clinical suspicion of ongoing myocardial ischaemia.  ECG interpretation is thus important for triage of patients.  Various criteria using ST-segment deviation concordant with QRS complex and excessive discordant ST-segment deviation have been proposed.   Sgarbossa criteria has high specificity (96%) but low sensitivity (36%).  Modified Sgarbossa criteria has better sensitivity (67%) with preserved specificity (90%).  The recently proposed Barcelona criteria was reported to have both high sensitivity (93%) and specificity (94%).



Interpreting the new ESC guidelines for Chronic Coronary Syndromes

Professor Robert Storey (UK)


The ESC recently published new guidelines on CCS, previously called “stable coronary artery disease” (sCAD). The terminology change emphasizes the dynamic nature of ischaemic heart disease, and facilitates the categorization of its varied clinical presentations. The guidelines contain a class I indication for initial CT angiography for diagnosing obstructive CAD, and review recent evidence of outcomes with different revascularization strategies. Other highlighted recommendations include the addition of a second antithrombotic drug to aspirin, eg. ticagrelor, for long-term secondary prevention in patients at high/moderately increased risk of ischaemic events and low bleeding risk, such as those with prior MI and concurrent DM, PAD and multivessel CAD.


ACS in Action CME Webinar: Connecting with The Experts

ACS in Action CME Webinar: Connecting with The Experts

17 August 2020

The second ACS in Action CME Webinar was held on 17 August 2020. At this meeting, two presentations on ECG diagnosis and the latest ESC guidelines on Chronic Coronary Syndromes (CCS) were given by esteemed local and international faculty. 

Duration: 50 minutes