Arq. Bras. Cardiol. 2025; 122(10): e20250109

Accuracy of Left Bundle Branch Block Chronology and Electrocardiography Criteria for Acute Myocardial Infarction Diagnosis: A Systematic Review and Meta-analysis

José Nunes de Alencar , Gleydson Wesley Freire Lima, Haissa Assad dos Santos Geraldo, Rinaldo Carvalho Fernandes, Matheus Kiszka Scheffer, Sandro Pinelli Felicioni, Mariana Fuziy Nogueira De Marchi

DOI: 10.36660/abc.20250109i

This Original Article is referred by the Short Editorial "LBBB and the Paradigm Shift from STEMI to Occlusion MI".

Abstract

Background

The diagnostic utility of new or presumed new left bundle branch block (LBBB) for acute myocardial infarction (AMI) in the setting of acute coronary syndrome (ACS) remains controversial.

Objective

To evaluate whether the timing of LBBB predicts AMI and to compare its diagnostic accuracy with ischemic electrocardiography (ECG) criteria, particularly the Modified Sgarbossa Criteria (MSC).

Methods

We searched PubMed and Scopus for studies involving patients with ACS with LBBB through December 2023. Sensitivity, specificity, positive (LR+) and negative (LR–) likelihood ratios, and diagnostic odds ratios (DOR) were calculated to assess diagnostic accuracy. Incidence and mortality data were also analyzed. Risk of bias was evaluated using the Newcastle-Ottawa Scale (NOS) and the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool.

Results

A total of 51 studies were included. LBBB occurred in 3.3% of ACS presentations and was associated with higher in-hospital mortality. Differentiating new from old LBBB was diagnostically neutral: LR+ 1.30 (95% CI: 0.75 to 1.85), LR– 0.90 (95% CI: 0.79 to 1.02), and DOR 1.44 (95% CI: 0.93 to 2.24); all confidence intervals crossed the null value of 1.0. In contrast, MSC demonstrated 83.6% sensitivity (95% CI: 55.4 to 95.5%) and 92.6% specificity (95% CI: 78.9 to 97.7%) for angiographically confirmed occlusive AMI, with LR+ 11.34 (95% CI: 3.67 to 34.99) and LR– 0.18 (95% CI: 0.054 to 0.575).

Conclusion

LBBB chronology alone does not significantly impact the likelihood of AMI. Ischemic ECG criteria — especially the MSC — provide substantially greater diagnostic accuracy and should guide clinical decision-making in ACS patients with LBBB.