ECG evaluation in patients with pacemaker and suspected acute coronary syndrome: Which score should we apply?

•Only Sgarbossa's score is validated for STEMI diagnosis in pacemaker patients.•Three ECG scores (Sgarbossa's, Smith's and Selvester's) were studied.•The most sensitive score was Selvester's while the most specific was Sgarbossa's.•Sequential application of these scores revealed clinically useful in this context.

Background/PurposeIn patients with right ventricular pacing, the ECG shows a left bundle branch block (LBBB) pattern. There are several criteria to diagnose ST-elevation myocardial infarction (STEMI) in patients with LBBB. The aim of this study was to validate and compare Sgarbossa's with two new scores – Selvester's and Smith's – in this context.MethodsWe identified pacemaker patients submitted to coronary angiography due to acute coronary syndrome. ECGs were analyzed by 2 blinded cardiologists. STEMI was defined according to angiographic and biochemical criteria. Sensitivity, specificity, positive and negative predictive values were calculated.ResultsForty-three patients with ventricular pacing were included for analysis. STEMI was diagnosed in 26 patients (60%). The most sensitive score was Selvester's (38.5%; 95% CI: 20.2–59.4) while the most specific was Sgarbossa's (100%; 95% CI: 80.5–100).ConclusionsThe sequential application of these scores proved to be clinically useful in the context of STEMI.