Recognition
- • Concordant ST ↑ ≥1 mm in leads with positive QRS (5 pts)
- • Concordant ST ↓ ≥1 mm in V1–V3 (3 pts)
- • Discordant ST ↑ ≥5 mm in leads with negative QRS (2 pts)
Key findings
- • Score ≥3 highly specific for STEMI in LBBB/paced rhythm
- • Modified Smith: ST/S ratio ≤ –0.25 more sensitive
Clinical importance
- • Allows identification of STEMI despite baseline LBBB
Management pearls
- • If Sgarbossa positive + symptoms → PPCI/fibrinolysis
