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A Score to differentiate Takotsubo syndrome from non-ST-elevation myocardial nfarction in women at the bedside
  1. Jen-Li Looi1,
  2. Katrina Poppe2,
  3. Mildred Lee1,
  4. Jill Gilmore1,
  5. Mark Webster3,
  6. Andrew To4 and
  7. Andrew J Kerr1
  1. 1Cardiology, Middlemore Hospital, Auckland, New Zealand
  2. 2Epidemiology & Biostatistics, University of Auckland, Auckland, New Zealand
  3. 3Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
  4. 4Lakeview Cardiology Centre, North Shore Hospital, Auckland, New Zealand
  1. Correspondence to Dr Jen-Li Looi; JenLi.Looi{at}


Objective A score to distinguish Takotsubo syndrome (TS) from acute coronary syndrome would be useful to facilitate appropriate patient investigation and management. This study sought to derive and validate a simple score using demographic, clinical and ECG data to distinguish women with non-ST elevation myocardial infarction (NSTEMI) from NSTE-TS.

Methods The derivation cohort consisted of women with NSTE-TS (n=100) and NSTEMI (n=100). Logistic regression was used to derive the score using ECG values available on the postacute ward round on day 1 post-hospital admission. The score was then temporally validated in subsequent consecutive patients with NSTE-TS (n=40) and NSTEMI (n=70).

Results The five variables in the score and their relative weights were: T-wave inversion in ≥6 leads (+3), recent stress (+2), diabetes (−1), prior cardiovascular disease (−2) and ST-depression in any lead (−3). When calculated using ECG values obtained at admission, discrimination between conditions was very good (area under the curve (AUC) 0.87 95% CI 0.83 to 0.92). The optimal score cut-point of ≥1 to predict NSTE-TS had 73% sensitivity and 90% specificity. When applied to the validation cohort at admission, AUC was 0.82 (95% CI 0.75 to 0.90) and positive and negative predictive values were 78% and 81%, respectively. On day 1 post-admission, AUC was 0.92 (95% CI 0.87 to 0.97), with positive and negative predictive values of 77% and 91%, respectively.

Conclusion This NSTE-TS score is easy to use and may prove useful in clinical practice to distinguish women with NSTE-TS from NSTEMI. Further validation in external cohorts is needed.

  • takotsubo syndrome
  • non-ST segment elevation myocardial infarction

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  • Contributors J-LL, MW, AT and AJK are involved in the design of this study. J-LL, KP and AJK are involved in drafting and revision of the manuscript. KP and ML are involved in the statistics section. JG is involved in data collection and interobserver variability for the ECG criteria.

  • Funding ML is supported by the Middlemore Hospital Cardiac Trust. KP is supported by the Heart Foundation Hynds Senior Fellowship. AJK receives salary support from the NZ Health Research Council.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the New Zealand Health and Disability Ethics Committees as observational research (Research Registration Number: 1763).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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