Modified Sgarbossa Criteria (Smith)
Modified Sgarbossa Criteria (Smith) - a deterministic tool in Sophie Well's Clinical Scoring & Risk group.
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What this is
Apply the modified Sgarbossa criteria (Smith) for diagnosing acute myocardial infarction in the presence of left bundle branch block or a ventricular paced rhythm. The three findings are: concordant ST elevation >=1 mm in any lead, concordant ST depression >=1 mm in V1-V3, and discordant ST elevation with an ST/S ratio <=-0.25 in any lead. Sophie Well presents each criterion as a checkbox and reports positive when any single finding is present. Source: Smith SW et al. Ann Emerg Med 2012;60:766-776.
When to use it
Use this when an ED or inpatient ECG shows LBBB or a paced rhythm and the clinical picture (ischemic chest pain, hemodynamic instability, or troponin elevation) raises the question of acute coronary occlusion. The original Sgarbossa rule had high specificity but poor sensitivity; the Smith-modified version replaces the discordant ST-elevation cutoff with the ST/S ratio and substantially improves sensitivity for occlusion MI without sacrificing specificity. A positive screen should prompt the same activation pathway as ST-elevation MI on a non-LBBB tracing.
References
Smith SW et al. Modified Sgarbossa criteria. Ann Emerg Med 2012;60:766-776.
Worked example: Positive (concordant ST elevation >=1 mm in at least one lead).
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