R.E.B.E.L.EM - January 11, 2016
"Background: Left Bundle Branch Block (LBBB) on the ECG makes accurate recognition of ST-Elevation Myocardial Infarction (STEMI) rather difficult. The 1996 and 2004 American College of Cardiology/American Heart Association (ACC/AHA) STEMI guidelines recommended immediate reperfusion therapy for patients with potentially ischemic symptoms and new, or presumed new, LBBB. In 2013, this recommendation was removed from the guidelines...
The modified Sgarbossa criteria replaces the absolute 5mm discordant ST elevation with a proportion (ST elevation/S-wave amplitude ≤ -0.25). In other words, the modified Sgarbossa criteria only changes the last of the original Sgarbossa criteria with the first two criteria staying intact. Now, if any of these criteria are met, the cardiac catheterization lab should be activated. We have written on REBEL EM before about the modified Sgarbossa criteria and one of our conclusions was this rule looked very promising, but needed an external validation study. Well that study is now here and for full disclosure I am one of the authors on the paper.
Author Conclusion: “The modified Sgarbossa criteria were superior to the original criteria for identifying ACO in LBBB.”
Clinical Take Home Point: The modified Sgarbossa criteria is superior to the original Sgarbossa criteria in identification of ACO in LBBB, and it is reasonable to start incorporating it into practice at this time as a supplement to clinical judgment."
References:
- Meyers HP et al. Validation of the Modified Sgarbossa Criteria for Acute Coronary Occlusion in the Setting of Left Bundle Branch Block: A Retrospective Case-Control Study. Am Heart J 2015; 170: 1255 – 1264. LINK HERE