EBQ:Sgarbossa Criteria Study

Under Review Journal Club Article

Sgarbossa E. et al.. "Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block. GUSTO-1 (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) Investigators". NEJM. 1996. 334(8):481-7.
PubMed Full text PDF

Clinical Question

How can we diagnose Acute Myocardial Infarction in patients with a Left Bundle Branch Block?

Conclusion

Sgarbossa's Criteria is a validated clinical prediction rule based on ECG criteria to diagnose Acute Myocardial Infarction in patients with a Left Bundle Branch Block. It has good specificity, but poor sensitivity.

Major Points

The Sgarbossa Criteria:

1. ST-segment Elevation of at least 1 mm with concordance with the QRS complex with a score of 5
2. ST-segment depression in leads V1, V2 or V3 with a score of 3
3. ST-segment Elevation of atleast 5 mm with discordance with the QRS complex with a score of 2

With a score >3 90% of those with positive criteria will have STEMI (Good Specificity) But with negative criteria it doesn't help that much (Low sensitivity)

Population

Patient Demographics

• Median Age: 68 years
• Males: 64% in study group and 60% in experimental group
• Left Axis Deviation: 28% Vs. 48%
• Previous MI: 26% Vs. 59%

Inclusion Criteria

• Experiment: Patients with LBBB and Acute myocardial infarction (GUSTO-1 trial population)
• Control: Patients with normal documented angiography with LBBB Randomly selected from Duke data bank for cardiovascular disease

Exclusion Criteria

Patients without LBBB

Outcomes

Primary Outcome

Acute Myocardial Infarction

Funding

Grant from Bayer, Genentech, CIBA–Corning, ICI Pharmaceuticals, and Sanofi Pharmaceuticals.