The GRACE scale in the prognosis of patients with Takotsubo syndrome

Abstract

Background The prognosis of Takotsubo syndrome (TTS) is comparable to that of the non-ST-elevation myocardial infarction (NSTEMI). The GRACE scale is used to assess the risk of premature and long-term mortality in patients with NSTEMI in order to select the most favorable treatment strategy. Methods 101 patients with TTS were hospitalized in 4 centers of invasive cardiology in Podlaskie Voivodeship during the period 2008–2012 were included in the study. The patients were divided into 2 groups: I – 52 patients (GRACE ≤140 points) and II – 49 patients (GRACE >140 points). Results The mean GRACE score in study group was 138.66. The course of Takotsubo in the patients with higher GRACE scores was associated with higher incidence of pneumonia (36,7% vs 7,69%, p=0,0004), rhythm abnormalities (17,3% vs 3,85%, p=0,026) and serious complications (cardiogenic shock, pulmonary edema, and sudden cardiac arrest) (30,6% vs 5,77%, p=0,001). The mean observation period was 7.2 years. A significantly higher risk of 6-month (18,37% vs 3,85%, p=0,019),1-year (22,45 vs 3,85%, p=0,005), 3-year (40,82 vs 3,85%, p<0,0001), 5-year (42,86% vs 3,85%, p<0,0001) and 7-year mortality (53,06% vs 9,62%, p<0,0001) was observed in the group of patients with a GRACE score ≥140. The death risk factors in the multivariate analysis performed were low BMI, low eGFR, and a higher GRACE score The ROC curve presents the discriminatory scores of the GRACE scale for the follow-up prognosis. The area under ROC curve (AUC) for the GRACE scale was 0.805 (95% CI - 0.718–0.892, p<0.001), with a cut-off value of 153 points, sensitivity of 74%, and specificity of 77% for TTS. Conclusion The GRACE scale is highly valuable for the prognosis of death risk in patients with TTS in the early and follow-up period. Funding Acknowledgement Type of funding source: None

TakoTsubo Syndrome: A Well-Known Disease but Not Everything Is Clear Yet

“…It is interesting to note that, despite indicators of poor outcome (male sex, age 70 years, and physical illness/comorbidity) are more consistent in ACS patients, both conditions are burdened by the same in-hospital complications, and similar short- and long-term outcomes [ 37 , 38 , 39 ]. In this regard, it has recently been shown that the GRACE score can be used in patients with TTS to predict the risk of short- and long-term mortality [ 40 ].…”