EMS 12-LEAD- Posted by Christopher Waltford on December 20, 2012
The 2013 make changes:
- "New or presumed new" Left Bundle Branch Block is no longer an indication for a STEMI.
- Providers should use Sgarbossa's criteria to diagnose STEMI in the presence of LBBB. (Editor's Note: we're going to go ahead and add that our readers should take this one step further and utilize Smith's modification to Sgarbossa's criteria.)
- Isolated ST-depression in V1-V4 is an indication of a posterior STEMI.
- Widespread ST-depression with ST-elevation in aVR is an indication of proximal LAD or LMCA occlusion. (Editor's Note: the evidence points more towards this being an indication of 3-vessel disease or near occlusion of the LAD/LMCA.)
- Hyperacute T-waves, e.g. de Winter ST/T-wave changes, are an early indicator of a STEMI."
*
Smith S et al. Ann Emerg Med 2012;60:766-776
Conclusion: "Replacement of the absolute ST-elevation measurement of greater than or equal to 5 mm in the third component of the Sgarbossa rule with an ST/S ratio less than 0.25 greatly improves diagnostic utility of the rule for STEMI. An unweighted rule using this criterion resulted in excellent prediction for acute coronary occlusion"
http://download.journals.elsevierhealth.com/pdfs/journals/0196-0644/PIIS0196064412013686.pdf
*
Modified Sgarbossa Rule. Brady B. ekgumen november 4th, 2013
*
Cai et al. Am Heart J 2013;166:409-13
..."We propose a diagnosis and triage algorithm incorporating the Sgarbossa criteria to quickly and accurately identify, among patients presenting with chest pain and new or presumably new LBBB, those with acute coronary artery occlusion..."
https://umem.org/files/uploads/1311092043_American_Heart_Journal_2013_MD.pdf