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Sgarbossa Criteria
Identify STEMI in the setting of left bundle branch block (LBBB) or paced rhythm where ST changes cannot be interpreted using standard criteria.
Indication
- Identify STEMI in the setting of left bundle branch block (LBBB) or paced rhythm where ST changes cannot be interpreted using standard criteria.
Criteria
- id: concordant_ste; label: Concordant ST elevation ≥1mm in leads with positive QRS (most specific); type: yesno; points: 5
- id: concordant_std; label: Concordant ST depression ≥1mm in V1, V2, or V3; type: yesno; points: 3
- id: discordant_ste; label: Discordant ST elevation ≥5mm in leads with negative QRS (original); type: yesno; points: 2
- id: modified; label: Modified (Smith): ST/S ratio ≤ -0.25 in any discordant lead; type: yesno; points: 1
Clinical pearls
- Concordant ST changes are always abnormal in LBBB — any concordant ST elevation or depression is Sgarbossa positive
- The Smith modification (ST/S ratio) dramatically improves sensitivity while maintaining specificity
- New LBBB with chest pain as a STEMI equivalent is now controversial and institution-specific
Source and review
- Sgarbossa EB et al. NEJM 1996; Smith SW et al. Ann Emerg Med 2012. Last reviewed: 2025-01-01