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Original Article
Published online: 2021-06-16
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Clinical characteristics and outcomes of patients with takotsubo syndrome versus spontaneous coronary artery dissection

Victoria L. Cammann, Annahita Sarcon, Konrad A. Szawan, Michael Würdinger, Saif Azam, Jerold Shinbane, Burkhardt Seifert, Jelena R. Ghadri, Jacqueline Saw, Christian Templin
DOI: 10.5603/CJ.a2021.0065
·
Pubmed: 34165180

open access

Ahead of print
Original articles
Published online: 2021-06-16

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 2 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 2 entities and aid in the appropriate risk stratification, diagnosis, and management.

Trial registration: ClinicalTrials.gov no. NCT01947621.

Get Citation

Keywords

takotsubo syndrome, spontaneous coronary artery dissection, myocardial infarction with non-obstructive coronary arteries (MINOCA)

About this article
Title

Clinical characteristics and outcomes of patients with takotsubo syndrome versus spontaneous coronary artery dissection

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Original Article

Published online

2021-06-16

DOI

10.5603/CJ.a2021.0065

Pubmed

34165180

Keywords

takotsubo syndrome
spontaneous coronary artery dissection
myocardial infarction with non-obstructive coronary arteries (MINOCA)

Authors

Victoria L. Cammann
Annahita Sarcon
Konrad A. Szawan
Michael Würdinger
Saif Azam
Jerold Shinbane
Burkhardt Seifert
Jelena R. Ghadri
Jacqueline Saw
Christian Templin

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