Key result
A five-parameter score including BNP/TnI ratio distinguished Takotsubo syndrome from STEMI (AUC 0.93), and a four-variable score distinguished it from NSTEMI (AUC 0.94).
Why the study?
Bedside diagnosis between Takotsubo syndrome (TTS) and STEMI or NSTEMI remains challenging, prompting the need for a cardiac biomarker profile to enable their early distinction.
Does a cardiac biomarker profile and clinical score improve the early distinction between Takotsubo syndrome and acute myocardial infarction?
Observational (n=334)
Yes
Does a cardiac biomarker profile and clinical score improve the early distinction between Takotsubo syndrome and acute myocardial infarction?
Effect estimate: AUC 0.93
A clinical score incorporating the BNP/TnI ratio, LVEF, and patient characteristics provides high diagnostic accuracy for distinguishing Takotsubo syndrome from acute myocardial infarction at admission.
May aid early TTS-STEMI differentiation at admission; leaves open prospective validation before practice change.
BACKGROUND: Bedside diagnosis between Takotsubo syndrome (TTS) and ST elevation (STEMI) and non-ST elevation (NSTEMI) myocardial infarction remains challenging. We sought to determine a cardiac biomarker profile to enable their early distinction. METHODS: = 334) were enrolled in two centers. Baseline clinical and biological characteristics were compared between groups. RESULTS: At admission, cut-off values of BNP (B-type natriuretic peptide)/TnI (Troponin I) ratio of 54 and 329 distinguished respectively STEMI from NSTEMI, and NSTEMI from TTS. Best differentiation was obtained by the use of BNP/TnI ratio at peak (cut-of values of 6 and 115 discriminated respectively STEMI from NSTEMI, and NSTEMI from TTS). We developed a score including five parameters (age, gender, history of psychiatric disorders, LVEF, and BNP/TnI ratio at admission) enabling good distinction between TTS and STEMI (77% specificity and 92% sensitivity, AUC 0.93). For the distinction between TTS and NSTEMI, a four variables score (gender, history of psychiatric disorders, LVEF, and BNP at admission) achieved a good diagnostic performance (89% sensitivity, 85% specificity, AUC 0.94). CONCLUSION: A distinctive cardiac biomarker profile enables at an early stage a differentiation between TTS and ACS. A four (NSTEMI) or five variables score (STEMI) permitted a better discrimination.
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Dagrenat et al. (2020) conducted an observational in Takotsubo syndrome, STEMI, and NSTEMI (n=334). Cardiac biomarker profile (BNP/TnI ratio and clinical scores) was evaluated on Distinction between Takotsubo syndrome and STEMI using a five-parameter score (AUC 0.93). A five-parameter score including BNP/TnI ratio distinguished Takotsubo syndrome from STEMI (AUC 0.93), and a four-variable score distinguished it from NSTEMI (AUC 0.94).
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