Sgarbossa Criteria

Sgarbossa Criteria: Used to identify acute myocardial infarction (AMI) in the presence of Left Bundle Branch Block (LBBB) or ventricular paced rhythm. A score ≥ 3 is highly specific for AMI.

Criteria Assessment

Guidelines & Evidence

Verified

Last Review: 2026-07-17

When to Use

Evaluation of suspected Acute Myocardial Infarction (AMI) in patients with a Left Bundle Branch Block (LBBB).

To differentiate baseline LBBB ST-changes from acute ischemia.

In patients with ventricularly paced rhythms (pacemaker).

How it Works

The Rule of Discordance

In normal LBBB, the ST segment and T wave should be "discordant" (opposite) to the main QRS deflection. Sgarbossa criteria identify AMI by looking for "concordance" (ST deviation in the same direction as the QRS) or "excessive discordance."

Scoring Criteria

Concordant ST elevation ≥ 1 mm in any lead	5 pts
Concordant ST depression ≥ 1 mm in lead V1, V2, or V3	3 pts
Discordant ST elevation ≥ 5 mm in leads with negative QRS	2 pts

Interpretation

A score ≥ 3 has a specificity of ~98% for AMI, though sensitivity is low (~20-30%).

Last Comprehensive Review: 2026-07-17

Guidelines & Evidence

Verified

Last Review: 2026-07-17

When to Use

Evaluation of suspected Acute Myocardial Infarction (AMI) in patients with a Left Bundle Branch Block (LBBB).

To differentiate baseline LBBB ST-changes from acute ischemia.

In patients with ventricularly paced rhythms (pacemaker).

How it Works

The Rule of Discordance

Scoring Criteria

Concordant ST elevation ≥ 1 mm in any lead	5 pts
Concordant ST depression ≥ 1 mm in lead V1, V2, or V3	3 pts
Discordant ST elevation ≥ 5 mm in leads with negative QRS	2 pts

Interpretation

A score ≥ 3 has a specificity of ~98% for AMI, though sensitivity is low (~20-30%).

Last Comprehensive Review: 2026-07-17

Recent Journal Updates

CancerJul 22, 2026

Results of second‐line therapy in adult Philadelphia chromosome‐positive acute lymphoblastic leukemia

Clinical Context

We think this has broad domain relevance to Sgarbossa Criteria (MI in LBBB).

JAMAJul 21, 2026

Correction to Primary Composite Outcome in a Trial of Transfusion Strategy

Clinical Context

We think this has broad domain relevance to Sgarbossa Criteria (MI in LBBB).

British J HaematologyJul 21, 2026

Optimizing post‐transplant tyrosine kinase inhibitor maintenance in Philadelphia chromosome‐positive acute lymphoblastic leukaemia: A risk‐adapted framework

Clinical Context

We think this has broad domain relevance to Sgarbossa Criteria (MI in LBBB).

Sgarbossa Criteria

Criteria Assessment

When to Use

When to Use

How it Works

The Rule of Discordance

Scoring Criteria

Interpretation

Clinical Pearls

LBBB = STEMI?

Next Steps

Complementary Calculators

The Evidence

Original Study

Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block.

When to Use

When to Use

How it Works

The Rule of Discordance

Scoring Criteria

Interpretation

Clinical Pearls

LBBB = STEMI?

Next Steps

Complementary Calculators

The Evidence

Original Study

Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block.

Recent Journal Updates

Sgarbossa Criteria

Criteria Assessment

When to Use

When to Use

How it Works

The Rule of Discordance

Scoring Criteria

Interpretation

Clinical Pearls

LBBB = STEMI?

Next Steps

Complementary Calculators

The Evidence

Original Study

Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block.

When to Use

When to Use

How it Works

The Rule of Discordance

Scoring Criteria

Interpretation

Clinical Pearls

LBBB = STEMI?

Next Steps

Complementary Calculators

The Evidence

Original Study

Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block.

Recent Journal Updates