Coexistence and outcome of coronary artery disease in Takotsubo syndrome
European Heart Journal
Abstract
Takotsubo syndrome (TTS) is an acute heart failure syndrome, which shares many features with acute coronary syndrome (ACS). Although TTS was initially described with angiographically normal coronary arteries, smaller studies recently indicated a potential coexistence of coronary artery disease (CAD) in TTS patients. This study aimed to determine the coexistence, features, and prognostic role of CAD in a large cohort of patients with TTS.
Coronary anatomy and CAD were studied in patients diagnosed with TTS. Inclusion criteria were compliance with the International Takotsubo Diagnostic Criteria for TTS, and availability of original coronary angiographies with ventriculography performed during the acute phase. Exclusion criteria were missing views, poor quality of angiography loops, and angiography without ventriculography. A total of 1016 TTS patients were studied. Of those, 23.0% had obstructive CAD, 41.2% had non-obstructive CAD, and 35.7% had angiographically normal coronary arteries. A total of 47 patients (4.6%) underwent percutaneous coronary intervention, and 3 patients had acute and 8 had chronic coronary artery occlusion concomitant with TTS, respectively. The presence of CAD was associated with increased incidence of shock, ventilation, and death from any cause. After adjusting for confounders, the presence of obstructive CAD was associated with mortality at 30 days. Takotsubo syndrome patients with obstructive CAD were at comparable risk for shock and death and nearly at twice the risk for ventilation compared to an age- and sex-matched ACS cohort.
Coronary artery disease frequently coexists in TTS patients, presents with the whole spectrum of coronary pathology including acute coronary occlusion, and is associated with adverse outcome.
ClinicalTrials.gov number: NCT01947621.
Contributors
Christina Chan
Author
Paul Bridgman
Author
L Christian Napp
Author
Daniel Beug
Author
Victoria L Cammann
Author
Milosz Jaguszewski
Author
Konrad A Szawan
Author
Manfred Wischnewsky
Author
Sebastiano Gili
Author
Maike Knorr
Author
Ibrahim El-Battrawy
Author
Susanne Heiner
Author
Rodolfo Citro
Author
Eduardo Bossone
Author
Fabrizio D’Ascenzo
Author
Michael Neuhaus
Author
Jennifer Franke
Author
Ioana Sorici-Barb
Author
Ibrahim Akin
Author
Christof Burgdorf
Author
Ekaterina Gilyarova
Author
Alexandra Shilova
Author
Wolfgang Koenig
Author
Behrouz Kherad
Author
Annahita Sarcon
Author
Lawrence Rajan
Author
Guido Michels
Author
John D Horowitz
Author
Alessandro Cuneo
Author
Claudius Jacobshagen
Author
Mahir Karakas
Author
Alexander Pott
Author
Jose D Arroja
Author
Adrian Banning
Author
Florim Cuculi
Author
Karolina Polednikova
Author
Richard Kobza
Author
Petr Tousek
Author
Thomas A Fischer
Author
Tuija Vasankari
Author
K E Juhani Airaksinen
Author
Petr Widimský
Author
Christian Hauck
Author
Carla Paolini
Author
David E Winchester
Author
Yoichi Imori
Author
Jan Galuszka
Author
Ken Kato
Author
Yoshio Kobayashi
Author
Christian Ukena
Author
Grzegorz Opolski
Author
Monika Budnik
Author
Gregor Poglajen
Author
Rafal Dworakowski
Author
Philip MacCarthy
Author
Christoph Kaiser
Author
Stefan Osswald
Author
Leonarda Galiuto
Author
Pedro Carrilho-Ferreira
Author
Carlo Di Mario
Author
Abhiram Prasad
Author
Charanjit S Rihal
Author
P Christian Schulze
Author
Filippo Crea
Author
Martin Borggrefe
Author
Lars S Maier
Author
Ruediger C Braun-Dullaeus
Author
Wolfgang Rottbauer
Author
Hugo A Katus
Author
Gerd Hasenfuß
Author
Carsten Tschöpe
Author
Burkert M Pieske
Author
Holger Thiele
Author
Heribert Schunkert
Author
Michael Böhm
Author
Stephan B Felix
Author
Thomas Münzel
Author
Jeroen J Bax
Author
Johann Bauersachs
Author
Eugene Braunwald
Author
Thomas F Lüscher
Author
Frank Ruschitzka
Author
Jelena R Ghadri
Author
Christian Templin
Author
