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30-Day mortality in the takotsubo syndrome compared to acute coronary syndromes
Authors : B Redfors (Gothenburg,SE), S Jha (Gothenburg,SE), O Angeras (Gothenburg,SE), C Dworeck (Gothenburg,SE), I Haraldsson (Gothenburg,SE), S Volz (Gothenburg,SE), J Odenstedt (Gothenburg,SE), G Hirlekar (Gothenburg,SE), P Petursson (Gothenburg,SE), E Omerovic (Gothenburg,SE)
B Redfors1
,
S Jha1
,
O Angeras1
,
C Dworeck1
,
I Haraldsson1
,
S Volz1
,
J Odenstedt1
,
G Hirlekar1
,
P Petursson1
,
E Omerovic1
,
1Sahlgrenska Academy, Univ. of Gothenburg, Dept of Molecular & Clinical Medicine/Cardiology - Gothenburg - Sweden
,
Background: The incidence of the Takotsubo syndrome (TS) has increased over the last decade, but high-quality outcomes data from large TS cohorts are scarce and the impact of TS on prognosis is poorly understood. Whereas prognosis in TS was first believed to be excellent recent reports imply as high risk of dying as for patients with acute myocardial infarction.
Purpose: We sought to compare the 30-day prognosis of patients with TS to that of patients with ST-elevation (STE) and non ST-elevation (NSTE) acute coronary syndromes (ACS).
Methods: Using data from the Swedish Coronary Angiography and Angioplasty Registry on procedures performed between 2009 and 2016 we compared patients with TS to patients with STE and NSTE ACS in regards to 30-day mortality. We adjusted for patient characteristics (age, sex, diabetes, smoking status, hypertension, hyperlipidemia, prior myocardial infarction and prior PCI) using multivariable Cox proportional hazards regression, which accounted for clustering of patients within hospitals.
Results: We identified 1950 patients (1465 [75.0%] women) with TS, 33727 patients (10256 [30.4%] women) with STE-ACS and 88659 patients (28768 [32.5%] women) with NSTE-ACS. The average age was similar among patients with TS (67.0 ± 11.4 years) and STE-ACS (67.1 ± 12.5, p=0.47), whereas patients with NSTE-ACS were older (67.9 ± 11.1 years, p=0.0003). The crude 30-day rate of all-cause mortality was 2.9% among patients with TS, which was higher than patients with NSTE-ACS (1.5%, p<0.0001) but lower than patients with STEMI (6.0%, p<0.0001). The adjusted 30-day risk of dying associated with TS remained lower than that of STE-ACS (adjusted hazard ratio [HR] 0.45, 95% confidence interval [CI] 0.32-0.63, p<0.0001) and similar to that of NSTE-ACS (adjusted HR 1.72, 95% CI 1.22-2.44, p<0.0001).
Conclusion: Patients with TS have unadjusted and adjusted short-term prognosis that is intermediate between NSTE-ACS and STE-ACS.
In line with the ESC mission, newly presented content is made available to all for a limited time (4 months for ESC Congress, 3 months for other events). ESC Professional Members, Association Members (Ivory & above) benefit from year-round access to all the resources from their respective Association, and to all content from previous years. Fellows of the ESC (FESC), and Professionals in training or under 40 years old, who subscribed to a Young Combined Membership package benefit from access to all ESC 365 content from all events, all editions, all year long. Find out more about ESC Memberships here.
