title: A novel clinical score (InterTAK Diagnostic Score) to differentiate takotsubo syndrome from acute coronary syndrome: results from the International Takotsubo Registry.
abstract: 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.
  
  
  
  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).
  
  
  
  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.
  
  
  
  NCT0194762.
authors.affiliation: University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Jelena R
authors.initials: JR
authors.lastname: Ghadri
authors.affiliation: University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Cammann
authors.affiliation: University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Stjepan
authors.initials: S
authors.lastname: Jurisic
authors.affiliation: Division of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
authors.forename: Burkhardt
authors.initials: B
authors.lastname: Seifert
authors.affiliation: Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
authors.forename: L Christian
authors.initials: LC
authors.lastname: Napp
authors.affiliation: University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Johanna
authors.initials: J
authors.lastname: Diekmann
authors.affiliation: University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Dana Roxana
authors.initials: DR
authors.lastname: Bataiosu
authors.affiliation: University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.affiliation: University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Katharina J
authors.initials: KJ
authors.lastname: Ding
authors.affiliation: University of Southern California, Keck School of Medicine, Division of Cardiovascular Medicine, Los Angeles, CA, USA.
authors.forename: Annahita
authors.initials: A
authors.lastname: Sarcon
authors.affiliation: University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Elycia
authors.initials: E
authors.lastname: Kazemian
authors.affiliation: University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Tanja
authors.initials: T
authors.lastname: Birri
authors.affiliation: University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Frank
authors.initials: F
authors.lastname: Ruschitzka
authors.affiliation: University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Lüscher
authors.affiliation: University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Templin
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis*; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D057216:Propensity Score; D011446:Prospective Studies; D012372:ROC Curve; D012042:Registries; D054549:Takotsubo Cardiomyopathy / Q000097:blood / Q000175:diagnosis*; D014336:Troponin / Q000097:blood*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D014336:Troponin; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Acute coronary syndrome; Broken heart syndrome; Clinical score ; Disease prevalence; Takotsubo (stress) syndrome