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The Sgarbossa Criteria for Diagnosing Acute Coronary Occlusion in Left Bundle Branch Block

The modified Sgarbossa criteria are the most accurate method for diagnosing acute coronary occlusion in patients with left bundle branch block, with superior sensitivity (80%) compared to the original criteria while maintaining high specificity (99%). 1

Original Sgarbossa Criteria (1996)

The original Sgarbossa criteria consist of three ECG findings:

  1. Concordant ST elevation ≥1 mm in leads with a positive QRS complex (5 points)
  2. Concordant ST depression ≥1 mm in leads V1-V3 (3 points)
  3. Excessively discordant ST elevation ≥5 mm in leads with a negative QRS complex (2 points)

A score of ≥3 points was considered diagnostic for acute MI in the setting of LBBB.

Modified Sgarbossa Criteria (2015)

The modified criteria replace the third criterion with a proportional measurement:

  1. Concordant ST elevation ≥1 mm in leads with a positive QRS complex
  2. Concordant ST depression ≥1 mm in leads V1-V3
  3. Proportionally excessive discordant ST elevation in leads with a negative QRS: ST elevation/S wave ≤ -0.25 (ratio rather than absolute measurement)

Any one criterion is considered positive for acute coronary occlusion.

Validation and Performance

The modified Sgarbossa criteria demonstrate:

  • Significantly higher sensitivity than the original weighted criteria (80% vs 49%, p<0.001)
  • Similar high specificity (99% vs 100%, p=0.5)
  • Superior performance compared to the original unweighted criteria in both sensitivity and specificity 1

Clinical Application

When evaluating a patient with LBBB and suspected acute coronary syndrome:

  1. Apply the modified Sgarbossa criteria to the 12-lead ECG

  2. Look specifically for:

    • Concordant ST elevation in any lead with positive QRS
    • Concordant ST depression in leads V1-V3
    • ST elevation/S wave ratio ≤ -0.25 in leads with negative QRS

  3. If any criterion is present, consider the patient as having acute coronary occlusion requiring urgent intervention

Important Considerations

  • The proportional measurement (ST/S ratio) accounts for QRS amplitude variability, making it more accurate than the fixed 5mm threshold in the original criteria
  • The modified criteria should be applied in clinical context with other findings (symptoms, cardiac biomarkers)
  • Early recognition of acute coronary occlusion in LBBB is critical for timely reperfusion therapy
  • False positives are rare (specificity 99%), making the modified criteria highly reliable for clinical decision-making

The modified Sgarbossa criteria represent an important advancement in ECG interpretation for patients with LBBB and suspected acute coronary occlusion, allowing for more accurate and timely diagnosis in this challenging clinical scenario.

References

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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