Difference between revisions of "Sgarbossa's criteria"

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==Background==
 
==Background==
*Assesses likelihood that pt w/ chest pain and baseline LBBB is having a STEMI
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*Assesses likelihood that patient with chest pain and baseline [[LBBB]] has myocardial damage
*Criteria do NOT need to be found in contiguous leads
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**Criteria also applies to [[LBBB]] due to ventricularly paced rhythm, with more recent reviews demonstrating ~98% specificity when QRS amplitude taken into consideration <ref>Maloy KR, Bhat R, Davis J, et al. Sgarbossa Criteria are highly specific for acute myocardial infarction with pacemakers. West J Emerg Med. 2010;11(4):354-357. (Retrospective cohort; 57 patients)</ref> <ref>Madias JE. The nonspecificity of ST-segment elevation > or =5.0 mm in V1-V3 in the diagnosis of acute myocardial infarction in the presence of ventricular paced rhythm. J Electrocardiol 2004 Apr; 37(2) 135-9.</ref>
*RBBB should NEVER have ST elevation  
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*Low sensitivity(20%), high specificity (98%)
*Low Sn, High Sp
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**Still consider PCI/t-PA for patients with LBBB and "good story" despite not meeting the criteria
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*Previously, a new or presumably new LBBB was indication for emergent reperfusion therapy (i.e. STEMI equivalent) 
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**Guidelines were changed in 2013 due to a high number of false positives
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**LBBB should now be taken into consideration, but no longer indication for emergent cardiac catheterization<ref>Cai et al. The left bundle-branch block puzzle in the 2013 ST-elevation myocardial infarction guideline: from fasely declaring emergnecy to denying reperfusion in a high-risk population. Are the Sgarbossa Criteria ready for prime time?. Am Heart J 2013 Sep; 166(3) 409-413. </ref>
  
 
==Criteria==
 
==Criteria==
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{{Sgarbossa Criteria}}
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[[File:Sgarbossa - all three.jpg|thumbnail|Sgarbossa original criteria]]
  
*ST elevation ≥1 mm in a lead with upward (concordant) QRS complex - 5 points
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==Management==
*ST depression ≥1 mm in lead V1, V2, or V3 - 3 points
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*Discussion with a cardiologist should precede activation of the Cath Lab for any of the Sgarbossa or modified Sgarbossa criteria
*ST elevation ≥5 mm in a lead with downward (discordant) QRS complex - 2 points
 
 
==Points==
 
*≥3 points = 98% probability of [[STEMI]]
 
  
 
==See Also==
 
==See Also==
[[ST-Elevation Myocardial Infarction (STEMI)]]
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*[[EBQ:Sgarbossa Criteria Study]]
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*[[ST-Elevation Myocardial Infarction (STEMI)]]
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*[[EBQ:Sgarbossa Criteria Study|Original Study - Sgarbossa Criteria for MI in LBBB]]
  
==Source==
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==External Links==
*Sgarbossa, American Heart Journal 2006
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*http://lifeinthefastlane.com/ecg-library/basics/sgarbossa/
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*http://emcrit.org/podcasts/left-bundle-branch-block/
  
[[Category:Cards]]
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==Video==
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{{#widget:YouTube|id=VX2HF3xIodQ}}
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==References==
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<references/>
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[[Category:Cardiology]]

Latest revision as of 02:31, 5 October 2019

Background

  • Assesses likelihood that patient with chest pain and baseline LBBB has myocardial damage
    • Criteria also applies to LBBB due to ventricularly paced rhythm, with more recent reviews demonstrating ~98% specificity when QRS amplitude taken into consideration [1] [2]
  • Low sensitivity(20%), high specificity (98%)
    • Still consider PCI/t-PA for patients with LBBB and "good story" despite not meeting the criteria
  • Previously, a new or presumably new LBBB was indication for emergent reperfusion therapy (i.e. STEMI equivalent)
    • Guidelines were changed in 2013 due to a high number of false positives
    • LBBB should now be taken into consideration, but no longer indication for emergent cardiac catheterization[3]

Criteria

Original Criteria

Sgarbossa's Original Criteria

≥3 points = 98% probability of STEMI[4]

  • ST elevation ≥1 mm in a lead with upward QRS complex (concordant) - 5 points
  • ST depression ≥1 mm in lead V1, V2, or V3 - 3 points
  • ST elevation ≥5 mm in a lead with downward QRS complex (discordant) - 2 points

Smith's modification[5]

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

Management

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

See Also

External Links

Video

References

  1. Maloy KR, Bhat R, Davis J, et al. Sgarbossa Criteria are highly specific for acute myocardial infarction with pacemakers. West J Emerg Med. 2010;11(4):354-357. (Retrospective cohort; 57 patients)
  2. Madias JE. The nonspecificity of ST-segment elevation > or =5.0 mm in V1-V3 in the diagnosis of acute myocardial infarction in the presence of ventricular paced rhythm. J Electrocardiol 2004 Apr; 37(2) 135-9.
  3. Cai et al. The left bundle-branch block puzzle in the 2013 ST-elevation myocardial infarction guideline: from fasely declaring emergnecy to denying reperfusion in a high-risk population. Are the Sgarbossa Criteria ready for prime time?. Am Heart J 2013 Sep; 166(3) 409-413.
  4. 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
  5. 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