Takotsubo syndrome vs anterior STEMI electrocardiography; a meta-analysis and systematic review

ABSTRACT

Background

Takotsubo syndrome (TTS) and its differentiation from anterior wall ST-elevation myocardial infarction on electrocardiography (ECG) has been a debate.

Methods

Six studies comparing ECG changes in TTS and AW-STEMI were identified. The primary endpoint was reciprocal changes, presence of Q-waves, and QT-interval. An unadjusted odds ratio (OR) with a 95% confidence interval (CI) was calculated using Review Manager (RevMan) 5.3.

Results

Six studies consisting of 1090 patients (TTS = 220, AW-STEMI = 870) were included.

Reciprocal changes on ECG were less commonly associated with TTS than AW STEMI with OR of 0.05 and 95%CI- 0.02–0.11 (P-<0.00001). Q-wave presence on ECG was comparable between the groups with OR-0.68, 95%CI-0.08–5.63 (p-0.72). QT interval on ECG was comparable between the two groups with OR-1.09, 95%CI-0.63–1.54 (p-<0.00001). There was minimal publication bias among the studies.

Conclusion

AW STEMI is associated with reciprocal changes. Q-waves and QT interval has no differentiating significance between AW STEMI and TTS.

KEYWORDS:

• Takotsubo syndrome
• TTS
• anterior-wall STEMI
• ECG changes

Article Highlights

• Absence of reciprocal changes in TTS is statistically significant differentiating ECG findings from AW-STEMI.

• Presence of Q wave or QT-interval changes are not differentiating features on ECG between TTS and AW-STEMI.

• Our meta-analysis forms so for the biggest sample size comparing TTS and AW-STEMI ECG changes.

• Better review on the topic of ECG differentiation of TTS and AW-STEMI.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose. 

Additional information

Funding

This paper was not funded.