Key result
Takotsubo syndrome was associated with a higher rate of in-hospital major adverse cardiovascular events compared to spontaneous coronary artery dissection (12% vs. 4.7%, P<0.001).
Why the study?
SCAD and Takotsubo syndrome are two relatively common nonatherosclerotic causes of acute coronary syndrome particularly frequent in women, but direct comparisons of their characteristics and outcomes are needed.
How do baseline characteristics and in-hospital outcomes compare between patients with spontaneous coronary artery dissection and Takotsubo syndrome?
Cohort (n=424)
Yes
How do baseline characteristics and in-hospital outcomes compare between patients with spontaneous coronary artery dissection and Takotsubo syndrome?
Patients with Takotsubo syndrome are older, have more cardiovascular risk factors, and experience worse in-hospital outcomes including higher mortality compared to patients with spontaneous coronary artery dissection.
Answers are grounded in this paper and cite their sources.
Warrants closer in-hospital monitoring for Takotsubo syndrome; leaves open causal mechanisms and generalizability.
BACKGROUND: Spontaneous coronary artery dissection (SCAD) and Takotsubo syndrome (TTS) constitute two relatively common nonatherosclerotic causes of acute coronary syndrome particularly frequent in women. METHODS: This study sought to compare the baseline clinical and angiographic characteristics and in-hospital outcomes of patients from two large prospective registries on SCAD and TTS (the prospective nation-wide Spanish SCAD Registry and a prospective single-center TTS registry). RESULTS: A total of 318 SCAD and 106 TTS consecutive patients were included. Most patients in both groups (88%) were women. Patients in the TTS group were older [74 (interquartile range, IQR 67-81) vs. 53 years-old (IQR 47-60), P < 0.001] and presented a higher prevalence of cardiovascular risk factors. Precipitating triggers were more frequent in TTS (56% vs. 42%, P = 0.009) but emotional stress was more common in the SCAD group (25% vs. 15%, P = 0.037). TTS patients showed a reduced release of cardiac biomarkers but had more severe left ventricular dysfunction (ejection fraction <50%: 73% vs. 12%, P < 0.001). In-hospital major adverse cardiovascular events occurred more frequently in TTS patients (12% vs. 4.7%, P < 0.001). Notably, TTS patients showed more frequently congestive heart failure (10% vs. 0.6%, P < 0.001), atrial fibrillation (11% vs. 1%, P < 0.001) and had a higher all-cause in-hospital mortality (5.7% vs. 1.3%, P = 0.032). CONCLUSION: TTS patients are older and present a higher prevalence of some cardiovascular risk factors than patients with SCAD. TTS is linked to a worse in-hospital prognosis with higher mortality.
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Salamanca et al. (2020) conducted a cohort in Spontaneous coronary artery dissection (SCAD) and Takotsubo syndrome (TTS) (n=424). Takotsubo syndrome (TTS) vs. Spontaneous coronary artery dissection (SCAD) was evaluated on In-hospital major adverse cardiovascular events (p=<0.001). Takotsubo syndrome was associated with a higher rate of in-hospital major adverse cardiovascular events compared to spontaneous coronary artery dissection (12% vs. 4.7%, P<0.001).
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