Modified Sgarbossa’s Criteria for MI in Left Bundle Branch Block

Modified Sgarbossa's Criteria for MI in Left Bundle Branch Block

Modified Sgarbossa’s Criteria for MI in Left Bundle Branch Block

Concordant ST elevation > 1mm in leads with a positive QRS complex:
No
Yes

Concordant ST depression > 1 mm in V1-V3:
No
Yes

ST Elevation at the J-point, relative to QRS onset, is at least 1 mm AND has an amplitude at least 25% of the preceding S-wave
An ST/S ratio of 0.20 is also very high and almost as specific as a 0.25 ratio:

No
Yes




Result
0 0

Modified Sgarbossa's Criteria for MI in Left Bundle Branch Block

In Normal for LBBB and placed rhythm – ST and T waves in opposite direction to QRS main vector:

It’s often difficult to identify an MI for patients with existing left bundle branch blocks (LBBB). About 1 in 200 patients with MI have LBBB. The Modified Sgarbossa’s Criteria is a well accepted approach at determining which LBBB are having an MI.

Concordant ST elevation >1 mm in leads with a positive QRS complexNo
 Yes
Concordant ST depression > 1 mm in V1-V3No
 Yes
ST Elevation at the J-point, relative to QRS onset, is at least 1 mm AND has an amplitude at least 25% of the preceding S-wave
An ST/S ratio of 0.20 is also very high and almost as specific as a 0.25 ratio
No
 Yes

Modified Sgarbossa’s Criteria are met if any criteria are positive.

To read Sgarbossa’s Criteria for MI in Left Bundle Branch Block:

Literature:
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. https://pubmed.ncbi.nlm.nih.gov/8559200/
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. https://pubmed.ncbi.nlm.nih.gov/22939607/
3. 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 Sep;166(3):409-13. doi: 10.1016/j.ahj.2013.03.032. Epub 2013 Aug 6. PubMed PMID: 24016487. https://pubmed.ncbi.nlm.nih.gov/24016487/

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