Sgarbossa’s Criteria for Acute MI in Left Bundle Branch Block
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Assess likelihood of acute myocardial infarction in patient with chest pain and baseline left bundle branch block (LBBB)
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.
|Concordant ST elevation >1 mm in leads with upward QRS||5|
|Concordant ST depression > 1 mm in V1-V3||3|
|Discordant ST elevation > 5 mm in leads with downward QRS||2|
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%
|1||Sgarbossa 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|
|2||Smith 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 & Illustrator: Sirikarn Napan, MD, FACC