Background: I saw a patient last month who had chest pain and an ECG showing an acute MI in the context of LBBB. The ECG did not meet the original Sgarbossa criteria but did when the modified rule was applied. I was suitably thrilled by this. No one else was. In fact, most of my colleagues were not familiar with the original Sgarbossa, let alone the modified version...

 

 

Warning: you can probably tell already that this post is going to be a little more nerdy and detailed than you're used to. Bear with me - Sgarbossa is not really difficult and it can really help when confronted with ECGs showing LBBB or ventricular pacing. The in-built ECG computer usually reports paced ECGs as: "no further analysis attempted". Be better than the machine! You can analyse them and, in particular, you can spot a STEMI with 80% sensitivity if you use the rule described below.

 

 

Dr Elena Sgarbossa proposed a clinical prediction rule for diagnosing acute myocardial infarction in the presence of LBBB way back in 1996 (in this paper). It consisted of 3 simple ECG criteria, and was later found to be equally helpful for diagnosing MI in the presence of a paced rhythm (see this post from The BREACH and the ESC guidelines on the management of STEMI here). What you may not know is that Dr Stephen Smith modified the Sgarbossa criteria in 2012 to make them more sensitive (this paper). Here we consider the proposed changes, and review a validation study that was published 3 years later.

 

 

Myers HP, Limkakeng T, 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 Dec;170(6):1255-64

 

 

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