# Sgarbossa criteria

Sgarbossa

Status: LIVE
Price: $0.005 USDC
`GET /api/calc/sgarbossa`
HTML: https://magentlab.com/docs/sgarbossa
Markdown: https://magentlab.com/docs/sgarbossa.md

Not a medical device. Not a diagnosis, dose, or listing recommendation.

## What it computes

Sum the three Sgarbossa 1996 GUSTO-1 ECG criteria in left bundle-branch block and return whether the total is ≥3.

## When to use

When an agent needs the published Sgarbossa 1996 point total from caller-assigned ECG flags and must not invent ST measurements or apply the Smith modification.

## When not to use

- Not a diagnosis of myocardial infarction, reperfusion decision, or STEMI equivalent.
- This is Sgarbossa 1996 GUSTO-1 scoring only. Not the Smith-modified Sgarbossa criteria.
- magent does not read the tracing. Each flag is caller-assigned.

## Formula

```
Sgarbossa = 5*concordant_st_elevation_1mm + 3*concordant_st_depression_v1_v3 + 2*discordant_st_elevation_5mm; max 10; score_ge_3 iff total >= 3
```

## Citation

[Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block](https://doi.org/10.1056/NEJM199602223340801)
Sgarbossa EB, Pinski SL, Barbagelata A, et al.
N Engl J Med. 1996;334(8):481-487
DOI: [10.1056/NEJM199602223340801](https://doi.org/10.1056/NEJM199602223340801)

## Worked example

### No criteria

Given: `concordant_st_depression_v1_v3=false, concordant_st_elevation_1mm=false, discordant_st_elevation_5mm=false`

1. score = 0
2. max_score 10
3. score_ge_3 false (threshold is ≥3)


### Concordant ST elevation ≥1 mm

Given: `concordant_st_depression_v1_v3=false, concordant_st_elevation_1mm=true, discordant_st_elevation_5mm=false`

1. concordant ST elevation → 5
2. score = 5
3. score_ge_3 true


## Also searched as

- Sgarbossa criteria
- Sgarbossa score
- LBBB AMI criteria
- GUSTO-1 Sgarbossa
- AMI with left bundle branch block
- concordant ST elevation LBBB
- Sgarbossa 1996

## Parameters

- `concordant_st_elevation_1mm` (boolean, required): Concordant ST elevation ≥1 mm in a lead with a positive QRS (Sgarbossa 1996, 5 points). true or false as assigned by the caller. magent does not measure the ECG.
- `concordant_st_depression_v1_v3` (boolean, required): Concordant ST depression ≥1 mm in V1, V2, or V3 (Sgarbossa 1996, 3 points). true or false as assigned by the caller. magent does not measure the ECG.
- `discordant_st_elevation_5mm` (boolean, required): Discordant ST elevation ≥5 mm (ST opposite QRS; Sgarbossa 1996, 2 points). true or false as assigned by the caller. magent does not measure the ECG. Not the Smith ST/S ratio.

## Bulk (POST)

POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement.

Method: `POST /api/calc/sgarbossa`
Max items: 25
Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic)
Status: PREVIEW

- 1 to 25 items. Each item uses the same keys as the GET query parameters.
- POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows.
- The first invalid item fails the whole request (index in the 400 JSON). You are not charged.
- HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row.
- Catalog misses (empty matches, found=false) stay paid 200s inside that slot.
- x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items.

Example request:

```json
{
  "items": [
    {
      "concordant_st_depression_v1_v3": "false",
      "concordant_st_elevation_1mm": "false",
      "discordant_st_elevation_5mm": "false"
    },
    {
      "concordant_st_depression_v1_v3": "false",
      "concordant_st_elevation_1mm": "false",
      "discordant_st_elevation_5mm": "false"
    }
  ]
}
```

Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/sgarbossa

Example 200:

```json
{
  "count": 2,
  "path": "/api/calc/sgarbossa",
  "items": [
    {
      "components": [
        {
          "factor": "concordant_st_elevation_1mm",
          "points": 0,
          "present": false
        },
        {
          "factor": "concordant_st_depression_v1_v3",
          "points": 0,
          "present": false
        },
        {
          "factor": "discordant_st_elevation_5mm",
          "points": 0,
          "present": false
        }
      ],
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Sgarbossa EB, Pinski SL, Barbagelata A, et al.",
        "doi": "10.1056/NEJM199602223340801",
        "id": "sgarbossa-1996",
        "pmid": "8559200",
        "source": "N Engl J Med. 1996;334(8):481-487",
        "title": "Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block"
      },
      "formula": "sgarbossa",
      "formula_expression": "Sgarbossa = 5*concordant_st_elevation_1mm + 3*concordant_st_depression_v1_v3 + 2*discordant_st_elevation_5mm; max 10; score_ge_3 iff total >= 3",
      "max_score": 10,
      "score": 0,
      "score_ge_3": false
    },
    {
      "components": [
        {
          "factor": "concordant_st_elevation_1mm",
          "points": 0,
          "present": false
        },
        {
          "factor": "concordant_st_depression_v1_v3",
          "points": 0,
          "present": false
        },
        {
          "factor": "discordant_st_elevation_5mm",
          "points": 0,
          "present": false
        }
      ],
      "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
      "citation": {
        "authors": "Sgarbossa EB, Pinski SL, Barbagelata A, et al.",
        "doi": "10.1056/NEJM199602223340801",
        "id": "sgarbossa-1996",
        "pmid": "8559200",
        "source": "N Engl J Med. 1996;334(8):481-487",
        "title": "Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block"
      },
      "formula": "sgarbossa",
      "formula_expression": "Sgarbossa = 5*concordant_st_elevation_1mm + 3*concordant_st_depression_v1_v3 + 2*discordant_st_elevation_5mm; max 10; score_ge_3 iff total >= 3",
      "max_score": 10,
      "score": 0,
      "score_ge_3": false
    }
  ]
}
```

## Response fields

- `formula` (string): sgarbossa
- `formula_expression` (string): Exact expression used
- `score` (integer): Sgarbossa 1996 points 0-10
- `max_score` (integer): 10
- `score_ge_3` (boolean): true iff score ≥ 3 (Sgarbossa 1996: specificity ~90% at this cutoff). Not a diagnosis.
- `components` (array): Per-criterion points
- `citation` (object): Sgarbossa et al. NEJM 1996 citation
- `disclaimer` (string): Not-a-device notice

## Example JSON

Frozen fixture. Not a live lookup.

```json
{
  "components": [
    {
      "factor": "concordant_st_elevation_1mm",
      "points": 0,
      "present": false
    },
    {
      "factor": "concordant_st_depression_v1_v3",
      "points": 0,
      "present": false
    },
    {
      "factor": "discordant_st_elevation_5mm",
      "points": 0,
      "present": false
    }
  ],
  "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.",
  "citation": {
    "authors": "Sgarbossa EB, Pinski SL, Barbagelata A, et al.",
    "doi": "10.1056/NEJM199602223340801",
    "id": "sgarbossa-1996",
    "pmid": "8559200",
    "source": "N Engl J Med. 1996;334(8):481-487",
    "title": "Electrocardiographic diagnosis of evolving acute myocardial infarction in the presence of left bundle-branch block"
  },
  "formula": "sgarbossa",
  "formula_expression": "Sgarbossa = 5*concordant_st_elevation_1mm + 3*concordant_st_depression_v1_v3 + 2*discordant_st_elevation_5mm; max 10; score_ge_3 iff total >= 3",
  "max_score": 10,
  "score": 0,
  "score_ge_3": false
}
```

## Errors

- HTTP 400 `invalid_flag`: boolean clinical flags must be true or false Returned before settlement; you are not charged.
- HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged.
- HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged.
- HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged.

Shared HTTP 402 and 503: https://magentlab.com/docs/payments

## Related tools

- [TIMI risk score for STEMI](https://magentlab.com/docs/timi-stemi) — Compute the TIMI risk score for ST-elevation myocardial infarction from published bedside factors at presentation.
- [HEART score](https://magentlab.com/docs/heart) — Compute the HEART score as age points plus caller-assigned history, ECG, risk factors, and troponin (each 0-2).

## Payment

Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s.

- GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall).
- HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote.
- Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering.
- Retry the same URL with PAYMENT-SIGNATURE (base64 JSON echoing accepted, payload, and extensions when present).
- Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402.

- offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront.
- offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization.

- not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search.

Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers).

Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments

Stdio MCP (one process per host): https://magentlab.com/docs/mcp

## Guarantees

- HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged.
- exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE.
- HTTP 402 is unpaid only. Do not sign a second authorization because of a 503.
- Execution is timeout-bounded and concurrency-capped.
- Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.