Clinical outcomes of patients presenting with spontaneous coronary artery dissection versus takotsubo syndrome: a propensity score analysis

Macaya, Fernando; Vedia, Óscar; Salazar, Carlos; Mejía‐Rentería, Hernán; Ruiz-Pizarro, Virginia; Salinas, Pablo; Gonzalo, Nieves; Pérez-Vizcayno, Marı́a José; Vilacosta, Isidre; Fernández‐Ortíz, Antonio; Macaya, Carlos; Escaned, Javier; Núñez‐Gil, Iván J.

doi:10.1177/2048872619886311

Cited by 8 publications

(8 citation statements)

References 35 publications

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“…As compared with female takotsubo patients, patients with coronary dissection show a worse long term clinical outcome, mainly due to rehospitalization for cardiac causes. 10 These data further confirm that primary takotsubo occurring due to emotional stress in females is a benign disease. 11 Data of the InterTAK registry confirm such a hypothesis, since patients with events related to emotional stress had a favourable short and long term prognosis, while patients with takotsubo secondary to physical activities, medical conditions and neurological disease had worse prognosis.…”

supporting

confidence: 59%

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Primary and secondary takotsubo syndrome: Pathophysiological determinant and prognosis

Galiuto¹,

Crea²

2020

European Heart Journal. Acute Cardiovascular Care

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supporting

confidence: 59%

supporting

confidence: 59%

Primary and secondary takotsubo syndrome: Pathophysiological determinant and prognosis

Galiuto¹,

Crea²

2020

European Heart Journal. Acute Cardiovascular Care

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“…The most frequent identifiable triggers in SCAD were an emotional stress followed by intense physical activity. Precipitating factor distribution in both groups did not differ from those seen in previous registries [11,17,18,25,26]. Of note, our cohort included a 41% rate of secondary TTS forms (physical factor as a potential trigger).…”

Section: Discussionmentioning

confidence: 59%

Non-atherosclerotic acute cardiac syndromes: spontaneous coronary artery dissection and Takotsubo syndrome. Comparison of long-term clinical outcomes

Salamanca,

García-Guimaraes,

Sabaté

et al. 2023

Coronary Artery Disease

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Background Spontaneous coronary artery dissection (SCAD) and Takotsubo syndrome (TTS) constitute two common causes of nonatherosclerotic acute cardiac syndrome particularly frequent in women. Currently, there is no information comparing long-term clinical outcomes in unselected patients with these conditions. Methods We compared the baseline characteristics, in-hospital outcomes, and the 12-month and long-term clinical outcomes of two large prospective registries on SCAD and TTS. Results A total of 289 SCAD and 150 TTS patients were included; 89% were women. TTS patients were older with a higher prevalence of cardiovascular risk factors. Precipitating triggers were more frequent in TTS patients, while emotional triggers and depressive disorders were more common in the SCAD group. Left ventricular ejection fraction was lower in TTS patients, but SCAD patients showed higher cardiac biomarkers. In-hospital events (43.3% vs. 5.2%, P<0.01) occurred more frequently in TTS patients. TTS patients also presented more frequent major adverse events at 12-month (14.7% vs. 7.1%, HR 5.3, 95% CI: 2.4–11.7, P<0.01) and long-term (median 36 vs. 31 months, P=0.41) follow-up (25.8% vs. 9.6%, HR 4.5, 95% CI: 2.5–8.2, P<0.01). Atrial fibrillation was also more frequent in TTS patients. Moreover, TTS patients presented a higher 12-month and long-term mortality (5.6% vs. 0.7%, P=0.01; and 12.6% vs. 0.7%, P<0.01) mainly driven by noncardiovascular deaths. Conclusion Compared to SCAD, TTS patients are older and present more cardiovascular risk factors but less frequent depressive disorder or emotional triggers. TTS patients have a worse in-hospital, mid-term, and long-term prognosis with higher noncardiac mortality than SCAD patients.

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“…Table 1 provides an overview of the characteristics of the 34 included studies 2,4‐6,11‐40 . The mean duration of follow‐up was 33 ± 20 months.…”

Section: Resultsmentioning

confidence: 99%

Mortality in spontaneous coronary artery dissection: A systematic review and meta‐analysis

Adams

Hughes

et al. 2021

Cathet Cardio Intervent

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Objective The aim of this systematic review and meta‐analysis was to provide a comprehensive estimate for spontaneous coronary artery dissection (SCAD) related mortality, and explore factors associated with an increased risk of death. Background SCAD is an infrequent but increasingly recognized cause of acute coronary syndrome. Despite a growing body of evidence, there have been few detailed examinations of SCAD associated mortality. Methods We searched MEDLINE, EMBASE, Cochrane, Web of Science and Google Scholar databases through May 7, 2020. We included studies reporting mortality data, confirmed SCAD with coronary angiography and included ≥10 participants. We excluded non‐English studies, conference abstracts, review articles and duplicate datasets. Random‐effects meta‐analysis and meta‐regression were used to evaluate estimates and predictors of mortality. Results From an initial 1,131 articles, 34 studies with 2,817 patients were eligible for inclusion. The weighted mean age was 50 years, and 84% of participants were female. The pooled estimate for SCAD mortality was 1% (Proportion 0.01; 95% CI, 0.00–0.02). The mean duration of follow‐up was 33 months. Meta‐regression showed male sex was associated with 3.5‐fold increased odds of mortality (OR, 3.50; 95% CI, 1.22–10.03). In addition, smoking (current or previous) was associated with a 15‐fold increased risk of mortality (OR 15.32; 95% CI, 2.88–81.41). Conclusions This meta‐analysis has shown that SCAD is associated with favorable survival outcomes with an estimated mortality of 1% over a mean follow‐up period of 33 months. We also found male sex and smoking were associated with an increased risk of mortality.

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Clinical outcomes of patients presenting with spontaneous coronary artery dissection versus takotsubo syndrome: a propensity score analysis

Cited by 8 publications

References 35 publications

Primary and secondary takotsubo syndrome: Pathophysiological determinant and prognosis

Primary and secondary takotsubo syndrome: Pathophysiological determinant and prognosis

Non-atherosclerotic acute cardiac syndromes: spontaneous coronary artery dissection and Takotsubo syndrome. Comparison of long-term clinical outcomes

Mortality in spontaneous coronary artery dissection: A systematic review and meta‐analysis

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