Sgarbossa's criteria

(Redirected from Sgarbossa criteria)

Background

  • Assesses likelihood that patient with chest pain and baseline LBBB has myocardial damage. Developed in 1996 by Elena Sgarbossa [1]
    • Criteria also applies to LBBB due to ventricularly paced rhythm, with more recent reviews demonstrating ~98% specificity when QRS amplitude taken into consideration [2] [3]
  • Original Criteria had low sensitivity(20%), high specificity (98%)
    • Two main issues suggested for low sensitivity of original rule. First, use of CK (with or without MB) for diagnosis of acute MI, not angiography. Therefore both STEMI & NSTEMI included in acute MI group. Second, anterior STEMI diagnosis limited by criteria absolute 5mm ST elevation[4]
    • 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[5]
  • Subsequent Smith Modification improves sensitivity (91%) for a slightly lower specificity (90%), and was validated by Meyers et al in 2015[6]

Criteria

Original Criteria

Sgarbossa's Original Criteria

≥3 points = 98% probability of STEMI[7]

  • 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[8]

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. Sgarbossa EB, Pinski SL, Barbagelata MD, et al. Electrocardiographic Diagnosis of Evolving Acute Myocardial Infarction in the Presence of Left Bundle-Branch Block. NEJM. 1996;334(8)
  2. 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)
  3. 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.
  4. Smith SW, Dodd KW, Henry TD 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. Annals of Emerg Med 2012;60(6)
  5. 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.
  6. Meyers HP, Limkakeng AT, Jaffa EJ et al. Validation of the modified Sgarbossa criteria for acute coronary occlusion in the setting of left bundle branch block: A retrospective case-control study. Am Heart J. 2015;170(6)1255-64.
  7. 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
  8. 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