Discrimination of stress (Takotsubo) cardiomyopathy from acute coronary syndrome with clinical risk factors and coronary evaluation in real-world clinical practice. (15th May 2017)

• Record Type: Journal Article
• Authors: Lee, So-Ryoung; Lee, Sang Eun; Rhee, Tae-Min; Park, Jin Joo; Cho, Hyunjai; Lee, Hae-Young; Choi, Dong-Ju; Oh, Byung-Hee
• Is Part Of: International journal of cardiology. Volume 235(2017)
• Page Start: 154
• Page End: 161
• Publication Date: 2017-05-15
• Subjects: SCMP stress cardiomyopathy -- ACS acute coronary syndrome -- LVEF left ventricular ejection fraction -- RWMA regional wall motion abnormality -- CE coronary evaluation -- CART classification and regression tree -- PCI percutaneous coronary intervention; Stress cardiomyopathy -- Takotsubo cardiomyopathy -- Acute coronary syndrome -- Coronary artery disease; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2017.02.071
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Diagnosing stress cardiomyopathy (SCMP) apart from acute coronary syndrome (ACS) is challenging since coronary evaluation is not always feasible in real-world clinical practice. We explored the current practice pattern of coronary evaluation in patients suspected to have SCMP and divulged the distinguishable features of SCMP from ACS. Methods and results: From 2010 to 2015, only 219 out of 691 (32%) hospitalized patients suspected to have SCMP have received coronary evaluation in two tertiary hospitals. After the evaluation, 66 patients (30%) turned out to have ACS. Coronary evaluation was performed based on coronary risk factors, clinical presentations, and test results including electrocardiograms (ECG), cardiac biomarkers, and echocardiography. Whereas initial presentations, ECG changes, cardiac biomarkers, and regional wall motion abnormality patterns were not significantly different, multivariate logistic regression analysis showed that age (≥ 70 years), diabetes, a history of percutaneous coronary intervention (PCI), and the absence of evident triggers were significant factors discriminating ACS from SCMP. A decision tree based on classification and regression analysis also revealed the consistent results. Conclusions: Although it is hard to differentiate SCMP from ACS merely based on clinical features, a substantial proportion of patients suspected to have SCMP did not undergo coronary evaluation to exclude ACS in real-world clinical practice. Coronary evaluation should be more actively performed in patients with old age, prior PCI history, diabetes, and less evident trigger.