ECG differences and ECG predictors in patients presenting with ST segment elevation due to myocardial infarction versus takotsubo syndrome

• Published in: International journal of cardiology. Heart & vasculature 2022-06, Vol.40 (June 2022), p.101047-101047, Article 101047
• Main Authors: Zeijlon, Rickard, Chamat, Jasmina, Le, Vina, Wågerman, Johan, Enabtawi, Israa, Jha, Sandeep, Mohammed, Mohammed Munir, Shekka Espinosa, Aaron, Angerås, Oskar, Råmunddal, Truls, Omerovic, Elmir, Redfors, Björn
• Format: Article
• Language: English
• Subjects: Arrhythmia; Cardiac and Cardiovascular Systems; ECG; Kardiologi; Original Paper; ST-elevation myocardial infarction; Takotsubo syndrome
• ISSN: 2352-9067; 2352-9067
• DOI: 10.1016/j.ijcha.2022.101047

[Display omitted] •Takotsubo syndrome and myocardial infarction can present with ST segment elevation.•ECG in Takotsubo resembles left anterior descending artery myocardial infarction.•Ventricular arrhythmia or death occur in both Takotsubo and myocardial infarction.•ST segment changes predict ventricular arrhythmia or death in myocardial infarction.•ST segment changes do not predict ventricular arrhythmia in Takotsubo syndrome. Previous studies comparing electrocardiogram (ECG) in Takotsubo syndrome (TS) versus ST elevation myocardial infarction (STEMI) included TS patients without ST elevation, did not consider the culprit lesion in STEMI or had groups that were unbalanced regarding sex and age. Accounting for these factors, we sought to conduct a more reliable comparison of ECG in TS with ST-elevation (STE-TS) versus STEMI. The secondary aim was to investigate if ST segment changes, T wave inversion or prolonged QT interval predicted ventricular arrhythmia or death in STE-TS and STEMI. All STE-TS patients who presented at Sahlgrenska University Hospital between 2008 and 2019 were matched by sex and age to STEMI patients. STEMI patients were subcategorized according to whether or not the culprit lesion was located in the left anterior descending artery (LAD). Baseline characteristics, in‐hospital outcomes and admission ECGs were analyzed. 104 STE-TS patients were sex- and age-matched with 274 STEMI patients (113 LAD-STEMI, 161 non-LAD STEMI). Admission ECG in STE-TS was more similar to LAD STEMI than non-LAD STEMI. Reciprocal ST depression was less common in STE-TS (7/104, 6.7%) compared with STEMI (112/274, 41%; p=