Modified Sgarbossa Criteria
As discussed in this article by Stephen Smith, modified Sgarbossa criteria have been created to improve diagnostic accuracy. The most important change is the modification of the rule for excessive discordance. The use of a 5 mm cutoff for excessive discordance was arbitrary and non-specific — for example, patients with LBBB and large voltages will commonly have ST deviations > 5 mm in the absence of ischaemia.
The modified rule is positive for STEMI if there is discordant ST elevation with amplitude > 25% of the depth of the preceding S-wave.
Modified Sgarbossa Criteria:
- ≥ 1 lead with ≥1 mm of concordant ST elevation
- ≥ 1 lead of V1-V3 with ≥ 1 mm of concordant ST depression
- ≥ 1 lead anywhere with ≥ 1 mm STE and proportionally excessive discordant STE, as defined by ≥ 25% of the depth of the preceding S-wave.
See the modified Sgarbossa criteria in action in this excellent case study by Stephen Smith.