Modified Sgarbossa Criteria

Modified Sgarbossa: Identifies acute MI in patients with LBBB or Ventricular Paced rhythms.

ECG Diagnostic Findings

Concordant ST Elevation ≥ 1mm

ST elevation in a lead with a positive QRS complex (most specific).

Concordant ST Depression ≥ 1mm in V1-V3

ST depression in leads with negative QRS (V1, V2, or V3).

Discordant ST/S ratio ≤ -0.25

Excessive discordance: ST elevation height / S wave depth ≤ -0.25 (Modified Smith criterion).

Guidelines & Evidence

Verified

Last Review: 2026-07-17

When to Use

Evaluation of suspected Acute Myocardial Infarction in the presence of LBBB.

Proposed as a more sensitive alternative to the original Sgarbossa criteria.

Last Comprehensive Review: 2026-07-17

Guidelines & Evidence

Verified

Last Review: 2026-07-17

When to Use

Evaluation of suspected Acute Myocardial Infarction in the presence of LBBB.

Proposed as a more sensitive alternative to the original Sgarbossa criteria.

Last Comprehensive Review: 2026-07-17

Recent Journal Updates

British J Clinical PharmacologyJul 22, 2026

CHATD Questionnaire: Development, Validation and Evaluation of Child and Parent Attitudes Towards Deprescribing

Clinical Context

We think this has broad domain relevance to Modified Sgarbossa Criteria.

JAMAJul 21, 2026

Correction to Primary Composite Outcome in a Trial of Transfusion Strategy

Clinical Context

We think this has broad domain relevance to Modified Sgarbossa Criteria.

PLOS MedicineJul 21, 2026

Optimising scale-up of injectable lenacapavir for HIV pre-exposure prophylaxis in South Africa: A modelling study and economic evaluation

Clinical Context

We think this has broad domain relevance to Modified Sgarbossa Criteria.

Modified Sgarbossa Criteria

When to Use

When to Use

How it Works

Smith’s Modification

The S/T Ratio

Clinical Pearls

Sensitivity Boost

Next Steps

Complementary Calculators

The Evidence

Validation Study

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.

When to Use

When to Use

How it Works

Smith’s Modification

The S/T Ratio

Clinical Pearls

Sensitivity Boost

Next Steps

Complementary Calculators

The Evidence

Validation Study

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.

Recent Journal Updates

Modified Sgarbossa Criteria

When to Use

When to Use

How it Works

Smith’s Modification

The S/T Ratio

Clinical Pearls

Sensitivity Boost

Next Steps

Complementary Calculators

The Evidence

Validation Study

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.

When to Use

When to Use

How it Works

Smith’s Modification

The S/T Ratio

Clinical Pearls

Sensitivity Boost

Next Steps

Complementary Calculators

The Evidence

Validation Study

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.

Recent Journal Updates