Comparison of on−admission ST−segment elevation tako−tsubo patients and myocardial infarction women: in−hospital course and long−term follow−up

Abstract

Background: Tako-tsubo cardiomyopathy (TTC) is an uncommon transient cardiomyopathy with a clinical and electrocardiographic (ECG) presentation similar to that of ST-elevation myocardial infarction (STEMI).
Aim: To compare clinical presentation, in-hospital course, and long-term outcomes in TTC female patients with on-admission ST-segment elevation and anterior STEMI female patients.
Methods: Consecutive TTC patients with on-admission ST-segment elevation were selected. Using a propensity score, a matching STEMI control group was put together. The patients were followed for a mean 1,002 ± 552 days. Major adverse cardiac events were defined as TTC recurrence, MI recurrence, heart failure requiring hospitalisation, percutaneous coronary intervention, coronary artery bypass grafting, stroke and death.
Results: Forty one TTC patients were enrolled, including 29 women with on-admission ST-segment elevation. The control group consisted of 46 STEMI women with left anterior descending occlusion. The ECG at presentation showed greater ST- -segment elevation (6.0 ± 1.6 vs 2.0 ± 1.2 mm, p < 0.01) in the control STEMI patients than in the TTC group. Also, baseline CK-MB (16.2 ± 20.6 vs 66.0 ± 125.2 ng/mL, p < 0.01) and troponin-I levels (2.99 ± 5.36 vs 42.70 ± 64.79 ng/mL, p < 0.01) were significantly higher in the STEMI patients. Echocardiography showed higher follow-up ejection fraction in the TTC than in the STEMI group (57.0 ± 8.0 vs 49.5 ± 8.8%, p < 0.01). During follow-up, there was no significant difference in the major adverse cardiac events rate between the TTC and STEMI groups (–24.1% vs 41.3%, p = 0.13).
Conclusions: Although there is some diversity in ECG, laboratory, and ECHO parameters, none of these patterns alone can reliably distinguish TTC from MI in female patients. TTC and STEMI females have similar in-hospital and long-term outcomes.