Sgarbossa's criteria

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  • Assesses likelihood that pt w/ chest pain and baseline LBBB has myocardial damage
    • Criteria also applies to LBBB due to paced rhythm
  • Low sensitivity(20%), high specificity (98%)
    • Still consider PCI/t-PA for pts w/ LBBB and "good story" despite not meeting the criteria


Original Criteria

Sgarbossa's Original Criteria
  • ≥3 points = 98% probability of STEMI[1]
  • ST elevation ≥1 mm in a lead with upward (concordant) QRS complex - 5 points
  • ST depression ≥1 mm in lead V1, V2, or V3 - 3 points
  • ST elevation ≥5 mm in a lead with downward (discordant) QRS complex - 2 points

Smith's modification

Smith's Modified Sgarbossa 3rd Rule
  • Changes the 3rd rule of original Sgarbossa's Criteria to be ST depression OR elevation discordant w/ the QRS complex and w/ a magnitude of at least 25% of the QRS increases Sn from 52% to 91% at the expense of reducing Sp from 98% to 90%[2]


  • Discussion with a cardiologist should precede activation of the Cath Lab for any of the Sgarbossa or modified Sgarbossa criteria

See Also

External Links


  1. 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
  2. Smith, S. et al. Diagnosis of ST-Elevation Myocardial Infarction in the Presence of Left Bundle Branch Block With the ST-Elevation to S-Wave Ratio in a Modified Sgarbossa Rule. 60(6). 766-776