TY - JOUR T1 - A Score to differentiate Takotsubo syndrome from non-ST-elevation myocardial nfarction in women at the bedside JF - Open Heart JO - Open Heart DO - 10.1136/openhrt-2019-001197 VL - 7 IS - 1 SP - e001197 AU - Jen-Li Looi AU - Katrina Poppe AU - Mildred Lee AU - Jill Gilmore AU - Mark Webster AU - Andrew To AU - Andrew J Kerr Y1 - 2020/03/01 UR - http://openheart.bmj.com/content/7/1/e001197.abstract N2 - 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. ER -