title: Sgarbossa Criteria are Highly Specific for Acute Myocardial Infarction with Pacemakers.
abstract: OBJECTIVE
  In 1996 Sgarbossa reviewed 17 ventricular-paced electrocardiograms (ECGs) in acute myocardial infarction (AMI) for signs of ischemia. Several characteristics of the paced ECG were predictive of AMI. We sought to evaluate the criteria in ventricular-paced ECGs in an emergency department (ED) cohort.
  
  
  METHODS
  Ventricular-paced ECGs in patients with elevated cardiac markers within 12 hours of the ED ECG and a diagnosis of AMI were identified retrospectively (n=57) and compared with a control group of patients with ventricular-paced ECGs and negative cardiac markers (n=99). A blinded board certified cardiologist reviewed all ECGs for Sgarbossa criteria. This study was approved by the institutional review board.
  
  
  RESULTS
  Application of Sgarbossa's criteria to the paced ECGs revealed the following: The sensitivity of "ST-segment elevation of 1 mm concordant with the QRS complex" was unable to be calculated as no ECG fit this criterion;For "ST-segment depression of 1 mm in lead V1, V2, or V3," the sensitivity was 19% (95% CI 11-31%), specificity 81% (95% CI 72-87%), with a likelihood ratio of 1.06 (0.63-1.64);For "ST-segment elevation >5mm discordant with the QRS complex," the sensitivity was 10% (95% CI 5-21%), specificity 99% (95% CI 93-99%), with a likelihood ratio of 5.2 (1.3 - 21).
  
  
  CONCLUSIONS
  In our review of ventricular-paced ECGs, the most clinically useful Sgarbossa criterion in identifying AMI was ST-segment elevation >5mm discordant with the QRS complex. This characteristic may prove helpful in identifying patients who may ultimately benefit from early aggressive AMI treatment strategies.
authors.affiliation: Georgetown University, Department of Emergency Medicine, Washington, DC.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Maloy
authors.forename: Rahul
authors.initials: R
authors.lastname: Bhat
authors.forename: Jonathan
authors.initials: J
authors.lastname: Davis
authors.forename: Kevin
authors.initials: K
authors.lastname: Reed
authors.forename: Richard
authors.initials: R
authors.lastname: Morrissey