Differences Between Takotsubo and the Working Diagnosis of Myocardial Infarction With Nonobstructive Coronary Arteries

Abstract

AimWhether Takotsubo syndrome (TTS) should be classified within myocardial infarction with non-obstructive coronary arteries (MINOCAs) is still controversial. The aim of this work was to evaluate the main differences between TTS and non-TTS MINOCAs.Methods and ResultsA cohort study based on two prospective registries: TTS from the RETAKO registry (N:1,015) and patients with non-TTS MINOCAs from contemporary records of acute myocardial infarction from five 5 national centers (N:1,080). Definitions and management recommended by the ESC were used. Survival analysis was based on the Cox regression analysis; propensity score matching (PS) was created to adjust prognostic variables. Takotsubo syndrome were more often women (85.9 vs. 51.9%; p < 0.001) and older (69.4 ± 12.5 vs. 64.5 ± 14.1 years; p < 0.001). Atrial fibrillation (AF) was more frequent in non-TTS MINOCAs (10.4 vs. 14.4%; p = 0.007). Psychiatric disorders were more prevalent in TTS (15.5 vs. 10.2%, p < 0.001). In-hospital mortality and complications were higher in TTS: 3.4 vs. 1.8%, (p = 0.015), and 25.8 vs. 11.5%, (p < 0.001). Global mortality before PS matching was 16.1% in non-TTS MINOCAs and 8.1% in TTS. Median follow-up was 32.4 months; after PS matching, TTS had fewer major adverse cardiovascular events (MACEs): hazard ratio (HR) 0.59; 95% CI 0.42–0.83. There were no differences in global mortality (HR 0.87; CI: 0.64–1.19), but TTS had lower cardiovascular mortality (HR 0.58; CI: 0.35–0.98).ConclusionCompared to the rest of MINOCAs, TTS presents a different patient profile and a more aggressive acute phase. However, its long-term cardiovascular prognosis is better. These results support that TTS should be considered a separate entity with unique characteristics and prognosis.

Myocardial infarction with nonobstructive coronaries (MINOCA) following rabies postexposure prophylaxis: A case report

“…Another entity with similar presentation that still puzzles cardiologists is Takotsubo syndrome and there are controversies surrounding whether it should be classified within MINOCA 12 . The absence of a stressful trigger with lack of apical ballooning and basal hyperkinesia often otherwise seen in Takotsubo syndrome, 13 along with evident hypokinetic RCA territory in echocardiography and ECG showing definitive ST elevation and reciprocal changes in this case led to the cardiology team choose MINOCA as a working diagnosis instead of Takotsubo syndrome.…”

“…Another entity with similar presentation that still puzzles cardiologists is Takotsubo syndrome and there are controversies surrounding whether it should be classified within MINOCA. 12 The absence of a stressful trigger with lack of apical ballooning and basal hyperkinesia often otherwise seen in Takotsubo syndrome, 13 While a diagnosis of MINOCA is fitting to this patient, it is important to raise the consideration of coronary slow flow phenomenon (CSFP), as the potential contributor to the observed clinical symptoms. CSFP is characterized by delayed contrast opacification in coronary vessels without significant obstructive coronary disease, and can lead to acute chest symptoms and even ECG changes suggestive of acute coronary syndrome (ACS), 14 which adds a layer of complexity to the diagnosis of this case.…”

Do Patients with Myocardial Infarction with Non-Obstructive Coronary Arteries Have Similar Prognosis Compared to Ones with MI-CAD?

“…7 TTS has a different clinical profile than MINOCA based on a retrospective study of 2 cohorts with the objective of comparing TTS with non-TTS MINOCAs cohort. 62 TTS presents a more aggressive clinical presentation, and worse in-hospital outcomes than MINOCA, while MINOCA has a worse long-term cardiovascular prognosis than TTS.…”

Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA): Focus on Coronary Microvascular Dysfunction and Genetic Susceptibility

“…This is usually consequent to a stressful event, which plays a vital role, leading to endothelial dysfunction and vasospasm [33]. Moreover, TTS shows clear differences from the rest of the MINOCA group: it presents a more aggressive clinical presentation and worse in-hospital outcomes with better long-term cardiovascular prognosis [34].…”