Arq. Bras. Cardiol. 2025; 122(10): e20250497
LBBB and the Paradigm Shift from STEMI to Occlusion MI
Jesse T.T McLaren
, Hans C. Helseth, Stephen W. Smith
This Short Editorial is referred by the Research article "Accuracy of Left Bundle Branch Block Chronology and Electrocardiography Criteria for Acute Myocardial Infarction Diagnosis: A Systematic Review and Meta-analysis".
The current paradigm for acute coronary syndrome (ACS) is based on ST elevation myocardial infarction (STEMI) electrocardiogram (ECG) criteria. This is defined as ST elevation in the absence of left bundle branch block (LBBB). Nevertheless, this creates an obvious dilemma: what about patients with LBBB? In their systematic review and meta-analysis of 51 studies, Alencar et al. help resolve longstanding debates by comparing guidelines with evidence. This not only clarifies how to address this specific diagnostic dilemma, but also how a paradigm shift from STEMI to Occlusion MI (OMI) could transform patient care.
As Alencar found, LBBB appeared in only 3.3% of ACS, but had higher mortality than acute MI without BBB. The current paradigm creates the twin dangers of unnecessary cath lab activation or even thrombolytics for LBBB without OMI, or delayed reperfusion for LBBB with OMI.
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