Sgarbossa Criteria history

Description

Sgarbossa rule, proposed for the diagnosis of acute myocardial infarction in the presence of left bundle branch block.

Sgarbossa Criteria can be used to assist in determining which patients with LBBB are having an AMI.

History

1996 – Sgarbossa proposed three absolute criteria used to diagnose AMI in patients with LBBB based on review of GUSTO-1

• Concordant ST elevation > 1mm in leads with a positive QRS complex (score 5)
• Concordant ST depression > 1 mm in V1-V3 (score 3)
• Excessively discordant ST elevation > 5 mm in leads with a -ve QRS complex (score 2)

These criteria are specific, but not sensitive for myocardial infarction. A total score of ≥ 3 is reported to have a specificity of 90% for diagnosing myocardial infarction.

2012 – SW Smith modified the third component of the original criteria criteria from absolute (>5mm discordant ST elevation) to proportional (any ST segment to S-wave ratio less than -0.25, with at least 1 mm ST elevation) improved prediction of acute coronary occlusion.

• ≥ 1 lead with ≥1 mm of concordant ST elevation
• ≥ 1 lead of V1-V3 with ≥ 1 mm of concordant ST depression
• ≥ 1 lead anywhere with ≥ 1 mm STE and proportionally excessive discordant STE, as defined by ≥ 25% of the depth of the preceding S-wave.

‘Replacement of the absolute ST-elevation measurement of greater than or equal to 5 mm in the third component of the Sgarbossa rule with an ST/S ratio less than -0.25 greatly improves diagnostic utility of the rule for STEMI. An unweighted rule using this criterion resulted in excellent prediction for acute coronary occlusion.’

Associated Persons

• Elena B Sgarbossa
• Steve W Smith

LITFL Links

• Sgarbossa Criteria

References

• Sgarbossa EB et al. Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block. GUSTO-1. N Engl J Med 1996; 334(8) 481-7
• 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; 60(6): 766-76.
• Smith SW. STEMI in the Presence of LBBB. EP Monthly April 2015.
• Cai Q, Mehta N, Sgarbossa EB, Pinski SL, Wagner GS, Califf RM, Barbagelata A. The left bundle-branch block puzzle in the 2013 ST-elevation myocardial infarction guideline: from falsely declaring emergency to denying reperfusion in a high-risk population. Are the Sgarbossa Criteria ready for prime time? Am Heart J. 2013; 166(3) :409-13
• Sgarbossa EB. Sgarbossa’s Criteria for MI in Left Bundle Branch Block. MDCalc
• Eponymythology. History of the Electrocardiogram. LITFL
• Burns E. Sgarbossa Criteria. LITFL ECG Library