Sgarbossa's criteria: Difference between revisions
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**Criteria also applies to [[LBBB]] due to ventricularly paced rhythm<ref>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.</ref> | **Criteria also applies to [[LBBB]] due to ventricularly paced rhythm<ref>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.</ref> | ||
*Low sensitivity(20%), high specificity (98%) | *Low sensitivity(20%), high specificity (98%) | ||
**Still consider PCI/t-PA for | **Still consider PCI/t-PA for patients w/ LBBB and "good story" despite not meeting the criteria | ||
==Criteria== | ==Criteria== | ||
Revision as of 16:50, 21 June 2016
Background
- Assesses likelihood that pt w/ chest pain and baseline LBBB has myocardial damage
- Low sensitivity(20%), high specificity (98%)
- Still consider PCI/t-PA for patients w/ LBBB and "good story" despite not meeting the criteria
Criteria
Original Criteria
≥3 points = 98% probability of STEMI[2]
- 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[3]
- 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%
Treatment
- Discussion with a cardiologist should precede activation of the Cath Lab for any of the Sgarbossa or modified Sgarbossa criteria
See Also
- EBQ:Sgarbossa Criteria Study
- ST-Elevation Myocardial Infarction (STEMI)
- Original Study - Sgarbossa Criteria for MI in LBBB
External Links
- http://lifeinthefastlane.com/ecg-library/basics/sgarbossa/
- http://emcrit.org/podcasts/left-bundle-branch-block/
Video
{{#widget:YouTube|id=VX2HF3xIodQ}}
References
- ↑ 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.
- ↑ 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
- ↑ 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