The presence of a Sgarbossa criteria score > 3 should prompt immediate cardiac catheterization lab activation.
There is obvious inferior ST elevation, with reciprocal ST Depression in aVL (inferior STEMI). There is also ST Depression in lead I. This is good evidence that the inferior STEMI is caused by an RCA occlusion. There is ST depression maximal in lead V2. Thus, there is a posterior STEMI. There is also ST depression in V5 and V6.
Where else is there evidence of STEMI?