title: Discrimination of stress (Takotsubo) cardiomyopathy from acute coronary syndrome with clinical risk factors and coronary evaluation in real-world clinical practice.
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.
  
  
  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 (≥70years), 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.
authors.affiliation: Division of Cardiology, Department of Internal Medicine/Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: So-Ryoung
authors.initials: SR
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Department of Internal Medicine/Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea. Electronic address: se2se2@snu.ac.kr.
authors.forename: Sang Eun
authors.initials: SE
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Department of Internal Medicine/Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Tae-Min
authors.initials: TM
authors.lastname: Rhee
authors.affiliation: Division of Cardiology, Department of Internal Medicine/Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors.forename: Jin Joo
authors.initials: JJ
authors.lastname: Park
authors.affiliation: Division of Cardiology, Department of Internal Medicine/Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Hyunjai
authors.initials: H
authors.lastname: Cho
authors.affiliation: Division of Cardiology, Department of Internal Medicine/Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Hae-Young
authors.initials: HY
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Department of Internal Medicine/Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors.forename: Dong-Ju
authors.initials: DJ
authors.lastname: Choi
authors.affiliation: Division of Cardiology, Department of Internal Medicine/Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Byung-Hee
authors.initials: BH
authors.lastname: Oh
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis; D003937:Diagnosis, Differential; D004452:Echocardiography / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D063189:Symptom Assessment / Q000379:methods; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology
chemical_list: D015415:Biomarkers
keywords: Acute coronary syndrome; Coronary artery disease; Stress cardiomyopathy; Takotsubo cardiomyopathy