Sgarbossa's criteria

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Background

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

Criteria

Original Criteria[1]

Sgarbossa's Original Criteria
  • ≥3 points = 98% probability of STEMI
  • 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]

Treatment

  • 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. http://lifeinthefastlane.com/ecg-library/basics/sgarbossa/

2. http://emcrit.org/podcasts/left-bundle-branch-block/

Source

  • Sgarbossa, American Heart Journal 2006
  • Sgarbossa, NEJM, February, 1996
  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