Sgarbossa’s Criteria for Acute MI in Left Bundle Branch Block

Clinical Use

Assesses likelihood of acute myocardial infarction in patient with chest pain and baseline left bundle branch block (LBBB)

Information

Sgarbossa’s Criteria1 derived from a cohort of 26,003 North American patients. Three ECG criteria with independent value in the diagnosis of acute myocardial infarction in patients with prior left bundle branch block are used.

Factorsscore
Concordant ST elevation >1 mm in leads with upward QRS5
Concordant ST depression > 1 mm in V1-V33
Discordant ST elevation > 5 mm in leads with downward QRS2

Sgarbossa’s Criteria are specific, but not sensitive for diagnosing acute myocardial infarction.

≥3 points – specificity of ≥90%, sensitivity as low as 36%

Modified Sgarbossa’s Criteria by Stephen Smith2 as follows:

1) Changing the 3rd component to be ST elevation OR depression discordant with the QRS complex and with a magnitude of ≥25% of the QRS complex.

2) Unweighted. It is positive if at least 1 component is met.

Modified Sgarbossa’s Rule – specificity of 88%, sensitivity 100%

References

1Sgarbossa EB, Pinski SL, Barbagelata A, Underwood DA, Gates KB, Topol EJ, Califf RM, Wagner GS. 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. N Engl J Med. 1996 Feb 22;334(8):481-7. Erratum in: N Engl J Med 1996 Apr 4;334(14):931. PubMed PMID: 8559200. Full Text
2Smith SW, Dodd KW, Henry TD, Dvorak DM, Pearce LA. 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. Ann Emerg Med. 2012 Dec;60(6):766-76. doi: 10.1016/j.annemergmed.2012.07.119. Epub 2012 Aug 31. Erratum in: Ann Emerg Med. 2013 Oct;62(4):302. PubMed PMID: 22939607. Full Text

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Developer: Sirikarn Napan, MD, FACC