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

1996Sgarbossa 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.

2012SW 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


LITFL Links


References


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Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and informatics. Asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | vocortex |

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