Methodological considerations for potential improvement of this study

To the Editor Nestelberger et al 1 performed a prospective observational study of patients with left bundle branch block (LBBB) and suspected acute coronary syndrome (ACS) to further elucidate the optimal strategy of evaluation for this population. Unfortunately there are several methodological problems which prevent the authors from realising the full clinical potential of their dataset. First, the study uses the diagnosis of acute myocardial infarction (AMI) as the primary outcome against which the ECG findings are judged, implying both that the role of the ECG is to diagnose all types of AMI, and that the authors expect such accuracy. This logic runs counter to the role of …