Sgarbossa's criteria

Background

  • Assesses likelihood that patient with chest pain and baseline LBBB has myocardial damage. Developed in 1996 by Elena Sgarbossa [1]
    • Criteria also applies to LBBB due to ventricularly paced rhythm, with more recent reviews demonstrating ~98% specificity when QRS amplitude taken into consideration [2] [3]
  • Original Criteria had low sensitivity(20%), high specificity (98%)
    • Two main issues suggested for low sensitivity of original rule. First, use of CK (with or without MB) for diagnosis of acute MI, not angiography. Therefore both STEMI & NSTEMI included in acute MI group. Second, anterior STEMI diagnosis limited by criteria absolute 5mm ST elevation[4]
    • Still consider PCI/t-PA for patients with LBBB and "good story" despite not meeting the criteria
  • Previously, a new or presumably new LBBB was indication for emergent reperfusion therapy (i.e. STEMI equivalent)
    • Guidelines were changed in 2013 due to a high number of false positives
    • LBBB should now be taken into consideration, but no longer indication for emergent cardiac catheterization[5]
  • Subsequent Smith Modification improves sensitivity (91%) for a slightly lower specificity (90%), and was validated by Meyers et al in 2015[6]

Criteria

Original Criteria

Sgarbossa's Original Criteria

≥3 points = 98% probability of STEMI[7]

  • 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[8]

Smith's Modified Sgarbossa 3rd Rule
  • 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%
Sgarbossa original criteria

Management

  • Discussion with a cardiologist should precede activation of the Cath Lab for any of the Sgarbossa or modified Sgarbossa criteria

See Also

External Links

References

  1. ↑ Sgarbossa EB, Pinski SL, Barbagelata MD, et al. Electrocardiographic Diagnosis of Evolving Acute Myocardial Infarction in the Presence of Left Bundle-Branch Block. NEJM. 1996;334(8)
  2. ↑ Maloy KR, Bhat R, Davis J, et al. Sgarbossa Criteria are highly specific for acute myocardial infarction with pacemakers. West J Emerg Med. 2010;11(4):354-357. (Retrospective cohort; 57 patients)
  3. ↑ 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.
  4. ↑ Smith SW, Dodd KW, Henry TD 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. Annals of Emerg Med 2012;60(6)
  5. ↑ Cai et al. The left bundle-branch block puzzle in the 2013 ST-elevation myocardial infarction guideline: from fasely declaring emergnecy to denying reperfusion in a high-risk population. Are the Sgarbossa Criteria ready for prime time?. Am Heart J 2013 Sep; 166(3) 409-413.
  6. ↑ Meyers HP, Limkakeng AT, Jaffa EJ et al. Validation of the modified Sgarbossa criteria for acute coronary occlusion in the setting of left bundle branch block: A retrospective case-control study. Am Heart J. 2015;170(6)1255-64.
  7. ↑ 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
  8. ↑ 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
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