Although the Smith-modified criteria have yet to be validated, this modification has been included in the rather useful MDCalc calculator and incorporated into a proposed amendment to the 2013 ACC/AHA STEMI guidelines that has been co-authored by Dr Sgarbossa herself \cite{Cai_2013}. In their algorithm, they propose that if full Sgarbossa criteria are not met, then the presence of discordant ST elevation with a ratio of 0.25 relative to the S wave should still be grounds for PCI activation (Figure \ref{fig:algorithm}).