Sgarbossa criteria

The diagnosis of new left bundle branch block (LBBB) or ventricular pacing (VP) and chest pain implies acute myocardial ischemia or infarction.
However, interpretation of repolarization in LBBB and VP can be challenging.

The (modified) Scarbossa criteria help to differentiate signs of acute ischemia in the ECG, which can be seen equivalent to myocardial infarction with ST elevation (STEMI).

Original Sgarbossa Criteria

There are 3 original criteria for myocardial ischemia in patients with lbbb:

  1. ST elevation > 1mm in one of the leads with positive QRS complex concordant to the R wave (5 points)
  2. ST depression > 1mm in one of the leads V1 - V3 concordant to the S wave (3 points)
  3. ST elevation >5mm discordant to the S wave (1 point)

A score of 3 or more is reported to be 90% specific for myocardial ischemia. However, sensitivity is low.

Modified Sgarbossa Criteria

Stephen Smith modified the Sgarbossa criteria to improce sensitivity. Because the cutoff of 5mm for discordant ST elevation (#3) was arbitrary, he proposed a relative ST elevation more than 25% of the preceding S wave amplitude.

Both other criteria (#1 and #2) remained unchanged.

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