Combining Sgarbossa and Selvester ECG criteria to improve STEMI detection in the presence of LBBB

ECG detection of ST-segment Elevation Myocardial Infarction (STEM!) in the presence of left bundle-branch block (LBBB) has long been a challenge. The purpose of this study was to add Selvester criteria (the 10% rule) to Sgarbossa criteria for further improved detection of STEM! in LBBB and report the combined performance. Source data of the study group (143 with acute MI and 239 controls) comes from multiple sources. Elements of the Sgarbossa criteria and Selvester criteria (ST elevation >; 10% of |SI-IRI plus STEMI limits) were tested separately and in combination with the Sgarbossa discordant ST elevation replaced by the 10% rule. The combined Sgarbossa and Selvester criteria improved the sensitivity to 39%, specificity to 89%, positive likelihood ratio to 3.6 and the negative likelihood ratio to 0.68 compared with 30% sensitivity, 88% specificity, 2.5 positive likelihood ratio and 0.80 negative likelihood ratio with Sgarbossa criteria alone.