open access
Clinical characteristics and outcomes of patients with takotsubo syndrome versus spontaneous coronary artery dissection
Affiliations- University Heart Center, Department of Cardiology, University Hospital Zurich, Switzerland
- Section of Cardiac Electrophysiology, Department of Medicine, University of California-San Francisco, CA, United States
- University of Southern California, Keck School of Medicine, Los Angeles, CA, United States
- Division of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
- Division of Cardiology, Vancouver General Hospital, Vancouver, British Columbia, Canada
open access
Abstract
Background: Takotsubo syndrome (TTS) and spontaneous coronary artery dissection (SCAD) are now increasingly recognized. Both conditions predominantly affect females; however, the exact pathophysiology remains unclear. Large multi-center databases can help elucidate the underlying mechanism and optimize treatments to improve outcomes by allowing us to compare features and outcomes of patients with TTS and patients with SCAD. Methods: Takotsubo syndrome patients were enrolled from the International Takotsubo Registry and compared to SCAD patients from the Canadian Spontaneous Coronary Artery Dissection Cohort Study. In total 2098 TTS patients and 750 SCAD patients were included in the present study. Results: More than 85% of patients in both groups were females. TTS patients were older compared to SCAD patients. Physical triggers were more common in TTS patients, while emotional triggers and non-identifiable triggering events were more common in SCAD patients. Left ventricular ejection fraction was more impaired in TTS compared to SCAD. TTS patients had more major cardiovascular risk factors, while SCAD patients had a higher rate of migraines and anxiety disorders than TTS patients. Thirty-day mortality was significantly higher in TTS patients, while 30-day stroke rates were comparable between groups. Conclusions: These findings suggest that women are at higher risk for TTS and SCAD compared to men, which should be considered in the differential diagnosis of those presenting with acute coronary syndrome. Additionally, emotional stressors play a significant role in triggering events particularly in younger women suffering from SCAD. The present findings may help clinicians better differentiate these two entities and aid in the appropriate risk stratification, diagnosis, and management. Trial registration: ClinicalTrials.gov no. NCT01947621.
Abstract
Background: Takotsubo syndrome (TTS) and spontaneous coronary artery dissection (SCAD) are now increasingly recognized. Both conditions predominantly affect females; however, the exact pathophysiology remains unclear. Large multi-center databases can help elucidate the underlying mechanism and optimize treatments to improve outcomes by allowing us to compare features and outcomes of patients with TTS and patients with SCAD. Methods: Takotsubo syndrome patients were enrolled from the International Takotsubo Registry and compared to SCAD patients from the Canadian Spontaneous Coronary Artery Dissection Cohort Study. In total 2098 TTS patients and 750 SCAD patients were included in the present study. Results: More than 85% of patients in both groups were females. TTS patients were older compared to SCAD patients. Physical triggers were more common in TTS patients, while emotional triggers and non-identifiable triggering events were more common in SCAD patients. Left ventricular ejection fraction was more impaired in TTS compared to SCAD. TTS patients had more major cardiovascular risk factors, while SCAD patients had a higher rate of migraines and anxiety disorders than TTS patients. Thirty-day mortality was significantly higher in TTS patients, while 30-day stroke rates were comparable between groups. Conclusions: These findings suggest that women are at higher risk for TTS and SCAD compared to men, which should be considered in the differential diagnosis of those presenting with acute coronary syndrome. Additionally, emotional stressors play a significant role in triggering events particularly in younger women suffering from SCAD. The present findings may help clinicians better differentiate these two entities and aid in the appropriate risk stratification, diagnosis, and management. Trial registration: ClinicalTrials.gov no. NCT01947621.
Keywords
takotsubo syndrome, spontaneous coronary artery dissection
About this articleTitle
Clinical characteristics and outcomes of patients with takotsubo syndrome versus spontaneous coronary artery dissection
Journal
Issue
Article type
Original Article
Pages
125-130
Published online
2021-06-16
Page views
3964
Article views/downloads
1046
DOI
10.5603/CJ.a2021.0065
Pubmed
Bibliographic record
Cardiol J 2023;30(1):125-130.
Keywords
takotsubo syndrome
spontaneous coronary artery dissection
Authors
Victoria L. Cammann
Annahita Sarcon
Konrad A. Szawan
Michael Würdinger
Saif Azam
Jerold Shinbane
Burkhardt Seifert
Jelena R. Ghadri
Jacqueline Saw
Christian Templin
References (22)- Agewall S, Beltrame JF, Reynolds HR, et al. ESC working group position paper on myocardial infarction with non-obstructive coronary arteries. Eur Heart J. 2017; 38(3): 143–153.
- Hayes SN, Kim ESH, Saw J, et al. Spontaneous coronary artery dissection: current state of the science: a Scientific Statement from the American Heart Association. Circulation. 2018; 137(19): e523–e557.
- Mahmoud AN, Taduru SS, Mentias A, et al. Trends of incidence, clinical presentation, and in-hospital mortality among women with acute myocardial infarction with or without spontaneous coronary artery dissection: a population-based analysis. JACC Cardiovasc Interv. 2018; 11(1): 80–90.
- Gianni M, Dentali F, Grandi AM, et al. Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review. Eur Heart J. 2006; 27(13): 1523–1529.
- Ghadri JR, Wittstein IS, Prasad A, et al. International expert consensus document on takotsubo syndrome (part I): clinical characteristics, diagnostic criteria, and pathophysiology. Eur Heart J. 2018; 39(22): 2032–2046.
- Ghadri JR, Cammann VL, Jurisic S, et al. A novel clinical score (InterTAK Diagnostic Score) to differentiate takotsubo syndrome from acute coronary syndrome: results from the International Takotsubo Registry. Eur J Heart Fail. 2017; 19(8): 1036–1042.
- Lyon AR, Rees PSC, Prasad S, et al. Stress (Takotsubo) cardiomyopathy--a novel pathophysiological hypothesis to explain catecholamine-induced acute myocardial stunning. Nat Clin Pract Cardiovasc Med. 2008; 5(1): 22–29.
- Saw J, Humphries K, Aymong E, et al. Spontaneous coronary artery dissection: clinical outcomes and risk of recurrence. J Am Coll Cardiol. 2017; 70(9): 1148–1158.
- Saw J, et al. Coronary angiogram classification of spontaneous coronary artery dissection. Catheter Cardiovasc Interv. 2014; 84(7): 1115–1122.
- Kelman L. Migraine changes with age: IMPACT on migraine classification. Headache. 2006; 46(7): 1161–1171.
- Freitag FG. Why do migraines often decrease as we age? Curr Pain Headache Rep. 2013; 17(10): 366.
- Jorm AF. Does old age reduce the risk of anxiety and depression? A review of epidemiological studies across the adult life span. Psychol Med. 2000; 30(1): 11–22.
- Lenze EJ, Wetherell JL. A lifespan view of anxiety disorders. Dialogues Clin Neurosci. 2011; 13(4): 381–399.
- Templin C, Ghadri JR, Diekmann J, et al. Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy. N Engl J Med. 2015; 373(10): 929–938.
- Saw J, Starovoytov A, Humphries K, et al. Canadian spontaneous coronary artery dissection cohort study: in-hospital and 30-day outcomes. Eur Heart J. 2019; 40(15): 1188–1197.
- Gili S, Cammann VL, Schlossbauer SA, et al. Cardiac arrest in takotsubo syndrome: results from the InterTAK Registry. Eur Heart J. 2019; 40(26): 2142–2151.
- Di Viece D, Citro R, Cammann VL. Outcomes Associated With Cardiogenic Shock in Takotsubo Syndrome: Results From the International Takotsubo Registry. Circulation. 2019; 139(3): 413–415.
- Rashed A, Won S, Saad M, et al. Use of the Impella 2.5 left ventricular assist device in a patient with cardiogenic shock secondary to takotsubo cardiomyopathy. BMJ Case Rep. 2015; 2015.
- Tweet MS, Hayes SN, Pitta SR, et al. Clinical features, management, and prognosis of spontaneous coronary artery dissection. Circulation. 2012; 126(5): 579–588.
- Kato K, Di Vece D, Cammann VL, et al. Takotsubo recurrence: morphological types and triggers and identification of risk factors. J Am Coll Cardiol. 2019; 73(8): 982–984.
- Angelini P. Recurrent takotsubo cardiomyopathy: an opportunity to clarify causation and prognosis. Tex Heart Inst J. 2018; 45(4): 252–253.
- Y-Hassan S, Böhm F. The causal link between spontaneous coronary artery dissection and takotsubo syndrome: A case presented with both conditions. Int J Cardiol. 2016; 203: 828–831.
