Sgarbossa's criteria - Revision history

Rossdonaldson1 at 19:47, 15 April 2026

2026-04-15T19:47:52Z

← Revisión anterior		Revisión del 19:47 15 abr 2026
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	==Management==		==Management==
	*~~Discussion~~ with a cardiologist ~~should precede~~ activation of the Cath Lab for any of the Sgarbossa or modified Sgarbossa criteria		*Patients meeting Sgarbossa criteria with LBBB or paced rhythm should be treated as STEMI equivalent
			*Activate cardiac catheterization lab per institutional protocol
			**Consider discussion with a cardiologist preceding activation of the Cath Lab for any of the Sgarbossa or modified Sgarbossa criteria

	==Disposition==		==Disposition==
	*~~Patients meeting Sgarbossa criteria with LBBB or paced rhythm should be~~ treated as STEMI ~~equivalent~~		*If treated as STEMI, admit to ICU/CCU with cardiology consultation
	*Activate cardiac catheterization lab per institutional protocol		*If criteria not met but clinical suspicion remains, admit for serial troponins and observation (e.g., telemetery/cardiac bed)
	*Admit to ICU/CCU with cardiology consultation
	*If criteria not met but clinical suspicion remains, admit for serial troponins and observation

	==See Also==		==See Also==
Línea 34:		Línea 34:
	==References==		==References==
	<references/>		<references/>

	[[Category:Cardiology]]		[[Category:Cardiology]]

Danbot: Add evidence-based Disposition section

2026-03-22T10:08:10Z

Add evidence-based Disposition section

← Revisión anterior		Revisión del 10:08 22 mar 2026
Línea 16:		Línea 16:
	==Management==		==Management==
	*Discussion with a cardiologist should precede activation of the Cath Lab for any of the Sgarbossa or modified Sgarbossa criteria		*Discussion with a cardiologist should precede activation of the Cath Lab for any of the Sgarbossa or modified Sgarbossa criteria

			==Disposition==
			*Patients meeting Sgarbossa criteria with LBBB or paced rhythm should be treated as STEMI equivalent
			*Activate cardiac catheterization lab per institutional protocol
			*Admit to ICU/CCU with cardiology consultation
			*If criteria not met but clinical suspicion remains, admit for serial troponins and observation

	==See Also==		==See Also==

Rossdonaldson1: /* Video */

2024-04-17T20:16:28Z

Video

← Revisión anterior		Revisión del 20:16 17 abr 2024
Línea 25:		Línea 25:
	*http://lifeinthefastlane.com/ecg-library/basics/sgarbossa/		*http://lifeinthefastlane.com/ecg-library/basics/sgarbossa/
	*http://emcrit.org/podcasts/left-bundle-branch-block/		*http://emcrit.org/podcasts/left-bundle-branch-block/

	~~==Video==~~
	~~{{#widget:YouTube\|id=VX2HF3xIodQ}}~~

	==References==		==References==
	<references/>		<references/>
	[[Category:Cardiology]]		[[Category:Cardiology]]

ProfOak at 18:54, 8 March 2021

2021-03-08T18:54:17Z

← Revisión anterior		Revisión del 18:54 8 mar 2021
Línea 1:		Línea 1:
	==Background==		==Background==
	*Assesses likelihood that patient with chest pain and baseline [[LBBB]] has myocardial damage		*Assesses likelihood that patient with chest pain and baseline [[LBBB]] has myocardial damage. Developed in 1996 by Elena Sgarbossa <ref>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)</ref>
	**Criteria also applies to [[LBBB]] due to ventricularly paced rhythm, with more recent reviews demonstrating ~98% specificity when QRS amplitude taken into consideration <ref>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)</ref> <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, with more recent reviews demonstrating ~98% specificity when QRS amplitude taken into consideration <ref>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)</ref> <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%)		*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<ref>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)</ref>
	**Still consider PCI/t-PA for patients with LBBB and "good story" despite not meeting the criteria		**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)		*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		**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<ref>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. </ref>		**LBBB should now be taken into consideration, but no longer indication for emergent cardiac catheterization<ref>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. </ref>
			*Subsequent Smith Modification improves sensitivity (91%) for a slightly lower specificity (90%), and was validated by Meyers et al in 2015<ref>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.</ref>

	==Criteria==		==Criteria==

ElavemanMD: /* Background */

2019-10-05T02:31:15Z

Background

← Revisión anterior		Revisión del 02:31 5 oct 2019
Línea 1:		Línea 1:
	==Background==		==Background==
	*Assesses likelihood that patient with chest pain and baseline [[LBBB]] has myocardial damage		*Assesses likelihood that patient with chest pain and baseline [[LBBB]] has myocardial damage
	**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, with more recent reviews demonstrating ~98% specificity when QRS amplitude taken into consideration <ref>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)</ref> <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 patients with LBBB and "good story" despite not meeting the criteria		**Still consider PCI/t-PA for patients with LBBB and "good story" despite not meeting the criteria

Ldperkins23: /* Background */

2018-09-10T01:04:42Z

Background

← Revisión anterior		Revisión del 01:04 10 sep 2018
Línea 4:		Línea 4:
	*Low sensitivity(20%), high specificity (98%)		*Low sensitivity(20%), high specificity (98%)
	**Still consider PCI/t-PA for patients with LBBB and "good story" despite not meeting the criteria		**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<ref>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. </ref>

	==Criteria==		==Criteria==

Neil.m.young: Text replacement - " w/ " to " with "

2016-07-12T03:13:24Z

Text replacement - " w/ " to " with "

← Revisión anterior		Revisión del 03:13 12 jul 2016
Línea 1:		Línea 1:
	==Background==		==Background==
	*Assesses likelihood that patient w/ chest pain and baseline [[LBBB]] has myocardial damage		*Assesses likelihood that patient with chest pain and baseline [[LBBB]] has myocardial damage
	**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 patients w/ LBBB and "good story" despite not meeting the criteria		**Still consider PCI/t-PA for patients with LBBB and "good story" despite not meeting the criteria

	==Criteria==		==Criteria==

Neil.m.young: Text replacement - "==Treatment==" to "==Management=="

2016-07-09T11:18:47Z

Text replacement - "==Treatment==" to "==Management=="

← Revisión anterior		Revisión del 11:18 9 jul 2016
Línea 9:		Línea 9:
	[[File:Sgarbossa - all three.jpg\|thumbnail\|Sgarbossa original criteria]]		[[File:Sgarbossa - all three.jpg\|thumbnail\|Sgarbossa original criteria]]

	==~~Treatment~~==		==Management==
	*Discussion with a cardiologist should precede activation of the Cath Lab for any of the Sgarbossa or modified Sgarbossa criteria		*Discussion with a cardiologist should precede activation of the Cath Lab for any of the Sgarbossa or modified Sgarbossa criteria

Neil.m.young: Text replacement - " pt " to " patient "

2016-07-02T15:42:56Z

Text replacement - " pt " to " patient "

← Revisión anterior		Revisión del 15:42 2 jul 2016
Línea 1:		Línea 1:
	==Background==		==Background==
	*Assesses likelihood that pt w/ chest pain and baseline [[LBBB]] has myocardial damage		*Assesses likelihood that patient w/ chest pain and baseline [[LBBB]] has myocardial damage
	**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%)

Ostermayer: Text replacement - " pts" to " patients"

2016-06-21T16:50:27Z

Text replacement - " pts" to " patients"

← Revisión anterior		Revisión del 16:50 21 jun 2016
Línea 3:		Línea 3:
	**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 ~~pts~~ w/ LBBB and "good story" despite not meeting the criteria		**Still consider PCI/t-PA for patients w/ LBBB and "good story" despite not meeting the criteria

	==Criteria==		==Criteria==