Differentiation of Takotsubo Cardiomyopathy from ST
Elevation Myocardial Infarction in Patients Activated
for Fast-Track Coronary Angiography
Thidaporn Tangkittikasem MD*, Nattawut Wongpraparut MD*, Pradit Panchavinnin MD*,
Damras Tresukosol MD*, Chunhakasem Chotinaiwattarakul MD***, Rewat Phankingthongkum MD*,
Wiwun Tungsubutra MD*, Suthipol Udompunturak MSc**, Rungtiwa Pongakasira BSc***
Affiliation :
* Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
** Clinical Epidemiology Unit, Office for Research and Development, Faculty of Medicine Siriraj Hospital,
Mahidol University, Bangkok, Thailand
*** Her Majesty’s Cardiac Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : To compare clinical and electrocardiographic (ECG) features between Takotsubo cardiomyopathy (TC) and
ST-elevation myocardial infarction (STEMI).
Material and Method: We retrospectively reviewed clinical, electrocardiographic, and laboratory features of 20 consecutive
TC patients and 155 consecutive STEMI patients who were activated for fast-track coronary angiography and were ultimately
diagnosed with either TC or STEMI and compared these data between the two groups.
Results : Patients with TC were older (p = 0.001), more often female (p = 0.001), had more often been triggered by intense
emotional or physical stress (p = 0.001) or illness (p = 0.001), and had a lower rate of smoking (p = 0.005) than STEMI
patients. Compared with patients who presented with anterior wall STEMI, those with TC less commonly had Q waves
(30.0% vs. 62.9%, p = 0.007) and reciprocal change (0.0% vs. 37.1%, p = 0.001), and had a lower rate of ST-segment
elevation in lead V1 (5.0% vs. 59.8%, p = 0.001). ST-segment depression was also more common in TC in lead aVR (20.0%
vs. 2.1%, p = 0.008). Previously proposed ECG criteria had low sensitivity, but high specificity in our patients. Our proposed
point scoring model includes the use of both clinical and ECG findings. According to our proposed model, a score ≥4 had
90% sensitivity and 98% specificity in differentiating TC from acute anterior STEMI (AUC = 0.976, p<0.001).
Conclusion : In patients activated for fast-track coronary angiography because of acute coronary ST-segment elevation
syndrome, a number of clinical and ECG features differ between TC patients and patients with true STEMI. Our proposed
point scoring model that uses clinical and ECG findings demonstrated improved diagnostic accuracy in differentiating TC
from acute anterior STEMI.
Keywords : Clinical and electrocardiographic findings, ST elevation myocardial infarction, Takotsubo cardiomyopathy
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