Validation of the modified Sgarbossa criteria for acute coronary occlusion in the setting of left bundle branch block: A retrospective case-control study.


The modified Sgarbossa criteria were proposed in a derivation study to be superior to the original criteria for diagnosing acute coronary occlusion (ACO) in left bundle branch block (LBBB). The new rule replaces the third criterion (5 mm of excessively discordant ST elevation [STE]) with a proportion (at least 1 mm STE and STE/S wave ≤-0.25). We sought to validate the modified criteria.This retrospective case-control study was performed by chart review in 2 tertiary care center emergency departments (EDs) and 1 regional referral center. A billing database was used at 1 site to identify all ED patients with LBBB and ischemic symptoms between May 2009 and June 2012. In addition, all 3 sites identified LBBB ACO patients who underwent emergent catheterization. We measured QRS amplitude and J-point deviation in all leads, blinded to outcomes. Acute coronary occlusion was determined by angiographic findings and cardiac biomarker levels, which were collected blinded to electrocardiograms. Diagnostic statistics of each rule were calculated and compared using McNemar's test.Our consecutive cohort search identified 258 patients: 9 had ACO, and 249 were controls. Among the 3 sites, an additional 36 cases of ACO were identified, for a total of 45 ACO cases and 249 controls. The modified criteria were significantly more sensitive than the original weighted criteria (80% vs 49%, P < .001) and unweighted criteria (80% vs 56%, P < .001). Specificity of the modified criteria was not statistically different from the original weighted criteria (99% vs 100%, P = .5) but was significantly greater than the original unweighted criteria (99% vs 94%, P = .004).The modified Sgarbossa criteria were superior to the original criteria for identifying ACO in LBBB.





Published Version (Please cite this version)


Publication Info

Meyers, H Pendell, Alexander T Limkakeng, Elias J Jaffa, Anjni Patel, B Jason Theiling, Salim R Rezaie, Todd Stewart, Cassandra Zhuang, et al. (2015). Validation of the modified Sgarbossa criteria for acute coronary occlusion in the setting of left bundle branch block: A retrospective case-control study. American heart journal, 170(6). 10.1016/j.ahj.2015.09.005 Retrieved from

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.



Brent Jason Theiling

Associate Professor of Emergency Medicine


Dr. Theiling is a board-certified emergency medicine physician with expertise in Emergency Department and hospital operations. He is currently the vice chair of operations for Duke University's Department of Emergency Medicine, as well as CSU Medical Director of the Emergency Services Clinical Service Unit for Duke University Hospital. This unit encompasses Duke's Emergency Department, Life Flight Critical Care transport teams, the Duke Trauma Center, Patient Transport and Emergency Management.

As an Associate Professor of Emergency Medicine at Duke University School of Medicine and works in providing high-quality emergency care.. Dr. Theiling also provides cutting-edge education to future emergency medicine providers, focusing on clinical emergency medicine and critical care, advancements in medical education and emergency department operations.

Dr. Theiling is also a member of the Duke Emergency Medicine Residency Core Faculty and has won multiple awards for his work in education and clinical care. He has over a dozen publications in peer-reviewed journals about clinical emergency medicine, advancements in medical education, emergency department operations and work with Duke Life Flight. He works closely with AMPA and is active in the organization.

Unless otherwise indicated, scholarly articles published by Duke faculty members are made available here with a CC-BY-NC (Creative Commons Attribution Non-Commercial) license, as enabled by the Duke Open Access Policy. If you wish to use the materials in ways not already permitted under CC-BY-NC, please consult the copyright owner. Other materials are made available here through the author’s grant of a non-exclusive license to make their work openly accessible.