A novel clinical score (InterTAK Diagnostic Score) to differentiate takotsubo syndrome from acute coronary syndrome: results from the International Takotsubo Registry
Jelena R Ghadri, Victoria L Cammann, Stjepan Jurisic, Burkhardt Seifert, L Christian Napp, Johanna Diekmann, Dana Roxana Bataiosu, Fabrizio D'Ascenzo, Katharina J Ding, Annahita Sarcon, Elycia Kazemian, Tanja Birri, Frank Ruschitzka, Thomas F Lüscher, Christian Templin, InterTAK co-investigators, Milosz Jaguszewski, Jennifer Franke, Hugo A Katus, Christof Burgdorf, Heribert Schunkert, Holger Thiele, Johann Bauersachs, Carsten Tschöpe, Lawrence Rajan, Guido Michels, Roman Pfister, Christian Ukena, Michael Böhm, Raimund Erbel, Alessandro Cuneo, Claudius Jacobshagen, Gerd Hasenfuß, Mahir Karakas, Wolfgang Koenig, Wolfgang Rottbauer, Samir M Said, Ruediger C Braun-Dullaeus, Florim Cuculi, Adrian Banning, Thomas A Fischer, Tuija Vasankari, K E Juhani Airaksinen, Marcin Fijalkowski, Andrzej Rynkiewicz, Grzegorz Opolski, Rafal Dworakowski, Philip MacCarthy, Christoph Kaiser, Stefan Osswald, Leonarda Galiuto, Filippo Crea, Wolfgang Dichtl, Wolfgang M Franz, Klaus Empen, Stephan B Felix, Clément Delmas, Olivier Lairez, Paul Erne, Stefan Frantz, Abhiram Prasad, Jeroen J Bax, Jelena R Ghadri, Victoria L Cammann, Stjepan Jurisic, Burkhardt Seifert, L Christian Napp, Johanna Diekmann, Dana Roxana Bataiosu, Fabrizio D'Ascenzo, Katharina J Ding, Annahita Sarcon, Elycia Kazemian, Tanja Birri, Frank Ruschitzka, Thomas F Lüscher, Christian Templin, InterTAK co-investigators, Milosz Jaguszewski, Jennifer Franke, Hugo A Katus, Christof Burgdorf, Heribert Schunkert, Holger Thiele, Johann Bauersachs, Carsten Tschöpe, Lawrence Rajan, Guido Michels, Roman Pfister, Christian Ukena, Michael Böhm, Raimund Erbel, Alessandro Cuneo, Claudius Jacobshagen, Gerd Hasenfuß, Mahir Karakas, Wolfgang Koenig, Wolfgang Rottbauer, Samir M Said, Ruediger C Braun-Dullaeus, Florim Cuculi, Adrian Banning, Thomas A Fischer, Tuija Vasankari, K E Juhani Airaksinen, Marcin Fijalkowski, Andrzej Rynkiewicz, Grzegorz Opolski, Rafal Dworakowski, Philip MacCarthy, Christoph Kaiser, Stefan Osswald, Leonarda Galiuto, Filippo Crea, Wolfgang Dichtl, Wolfgang M Franz, Klaus Empen, Stephan B Felix, Clément Delmas, Olivier Lairez, Paul Erne, Stefan Frantz, Abhiram Prasad, Jeroen J Bax
Abstract
Aims: Clinical presentation of takotsubo syndrome (TTS) mimics acute coronary syndrome (ACS) and does not allow differentiation. We aimed to develop a clinical score to estimate the probability of TTS and to distinguish TTS from ACS in the acute stage.
Methods and results: Patients with TTS were recruited from the International Takotsubo Registry ( www.takotsubo-registry.com) and ACS patients from the leading hospital in Zurich. A multiple logistic regression for the presence of TTS was performed in a derivation cohort (TTS, n = 218; ACS, n = 436). The best model was selected and formed a score (InterTAK Diagnostic Score) with seven variables, and each was assigned a score value: female sex 25, emotional trigger 24, physical trigger 13, absence of ST-segment depression (except in lead aVR) 12, psychiatric disorders 11, neurologic disorders 9, and QTc prolongation 6 points. The area under the curve (AUC) for the resulting score was 0.971 [95% confidence interval (CI) 0.96-0.98] and using a cut-off value of 40 score points, sensitivity was 89% and specificity 91%. When patients with a score of ≥50 were diagnosed as TTS, nearly 95% of TTS patients were correctly diagnosed. When patients with a score ≤31 were diagnosed as ACS, ∼95% of ACS patients were diagnosed correctly. The score was subsequently validated in an independent validation cohort (TTS, n = 173; ACS, n = 226), resulting in a score AUC of 0.901 (95% CI 0.87-0.93).
Conclusion: The InterTAK Diagnostic Score estimates the probability of the presence of TTS and is able to distinguish TTS from ACS with a high sensitivity and specificity.
Trial registration: NCT0194762.
Trial registration: ClinicalTrials.gov NCT01947621.
Keywords: Acute coronary syndrome; Broken heart syndrome; Clinical score; Disease prevalence; Takotsubo (stress) syndrome.
© 2016 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
Source: PubMed