RT Journal
A1 Shlipak MG, Go AS, Browner WS
T1 LEft bundle-branch block and the ecg in diagnosis of acute myocardial infarction—reply
JF JAMA
JO JAMA
YR 1999
FD October 6
VO 282
IS 13
SP 1224
OP 1225
DO 10-1001/pubs.JAMA-ISSN-0098-7484-282-13-jbk1006
UL http://dx.doi.org/10-1001/pubs.JAMA-ISSN-0098-7484-282-13-jbk1006
AB 
The poor prognosis for patients with right BBB who experience myocardial
infarction has been demonstrated by many prior investigators,2
and was confirmed by recent work in which the in-hospital mortality for these
patients was 22.6%, nearly identical to that in patients with left BBB (23%).3 In designing our decision analysis, we were aware
that the FTT analysis included some patients with right BBB within the designation
of "bundle-branch block."4 That this category
has a predominance of patients with right BBB is speculation on the part of
Sgarbossa and colleagues. We chose the estimate of thrombolytic-related stroke
from the entire sample of the trials because the relatively small sample of
the BBB subgroup made that stroke estimate imprecise. However, we did perform
our analysis using the stroke value mentioned by Sgarbossa and colleagues
(2.1%). Under these conditions, the threshold for the likelihood of AMI such
that "thrombolysis for all" is superior to "apply ECG algorithm" increased
to 16%, but was still less than the rate of AMI we actually found of 28% (95%
CI, 17%-40%).