Spontaneous coronary artery dissection and Takotsubo syndrome: comparison of baseline clinical and angiographic characteristics and in-hospital outcomes

Abstract

Background Spontaneous coronary artery dissection (SCAD) and Takotsubo syndrome (TTS) constitute two relatively common nonatherosclerotic causes of acute coronary syndrome particularly frequent in women. Methods This study sought to compare the baseline clinical and angiographic characteristics and in-hospital outcomes of patients from two large prospective registries on SCAD and TTS (the prospective nation-wide Spanish SCAD Registry and a prospective single-center TTS registry). Results A total of 318 SCAD and 106 TTS consecutive patients were included. Most patients in both groups (88%) were women. Patients in the TTS group were older [74 (interquartile range, IQR 67–81) vs. 53 years-old (IQR 47–60), P < 0.001] and presented a higher prevalence of cardiovascular risk factors. Precipitating triggers were more frequent in TTS (56% vs. 42%, P = 0.009) but emotional stress was more common in the SCAD group (25% vs. 15%, P = 0.037). TTS patients showed a reduced release of cardiac biomarkers but had more severe left ventricular dysfunction (ejection fraction <50%: 73% vs. 12%, P < 0.001). In-hospital major adverse cardiovascular events occurred more frequently in TTS patients (12% vs. 4.7%, P < 0.001). Notably, TTS patients showed more frequently congestive heart failure (10% vs. 0.6%, P < 0.001), atrial fibrillation (11% vs. 1%, P < 0.001) and had a higher all-cause in-hospital mortality (5.7% vs. 1.3%, P = 0.032). Conclusion TTS patients are older and present a higher prevalence of some cardiovascular risk factors than patients with SCAD. TTS is linked to a worse in-hospital prognosis with higher mortality.

Takotsubo Cardiomyopathy and Trauma: The Role of Injuries as Physical Stressors

“…The most common comorbidities we found were hypertension, congestive heart failure, COPD, and diabetes, consistent with previous reports [ 12 , 21 , 22 , 25 - 27 ]. However, other studies have reported the most common comorbidities as smoking, alcohol abuse, anxiety states, and hyperlipidemia [ 24 ].…”

“…Our findings for in-hospital outcomes in the trauma population differ compared to the existing literature. The in-hospital mortality rate in the NTDB associated with TCC was higher compared to reported rates of 1.0-6% across various populations [ 6 , 14 , 22 , 23 , 25 , 27 ], which includes the 4.39% overall mortality rate of trauma patients, according to the NTDB report in 2016 [ 28 ]. The 11.7% mortality rate in trauma patients with TTC may be related to the higher number of patients with ISS > 25 (17.8%), as the mortality rate in trauma increases with higher ISS levels.…”

Recurrent Spontaneous Coronary Artery Dissection: Association with Takotsubo Syndrome and Fibromuscular Dysplasia; Comprehensive Review

“…Compared to TS, patients with SCAD are significantly younger. Patients with TS have worse in-hospital complications and outcomes including a higher risk of mortality during the index admission compared with SCAD [43]. Cammann et al [46] reported that left ventricular ejection was more impaired in TS compared to SCAD.…”

“…The authors concluded that TS may be a plausible cause for SCAD. Salamanca et al [43] performed left ventriculography in 72 (23%) out of 318 patients with SCAD. Fourteen (19%) of 72 patients had TS-like apical ballooning pattern on the left ventricular angiogram.…”

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

“…In spite of the aforementioned spontaneous healing of the affected vessel in SCAD and the wall motion abnormalities recovery in TTS, both clinical entities present substantial morbidity and mortality during in-hospital and long-term follow-up [8][9][10][11][12]. However, scarce information is available directly comparing the long-term follow-up of these two clinical entities.…”