Key result
In a systematic review of 20 case reports of SCAD-associated takotsubo syndrome, 95% of cases had SCAD on coronary angiography and all 20 patients recovered and survived.
Why the study?
SCAD and takotsubo syndrome can share clinical appearances or co-occur, challenging clinical management, but case reports lack consolidated data.
Systematic Review (n=20)
Yes
SCAD and Takotsubo syndrome can co-occur or present similarly, with all reviewed cases showing recovery, highlighting the need for careful angiographic and imaging evaluation.
SCAD-TTS overlap warrants routine angiography and imaging in suspected cases; leaves open true incidence and management strategies.
BACKGROUND: Spontaneous coronary artery dissection (SCAD) is underdiagnosed and requires comprehensive angiographic findings. Few SCAD occurrences have a comparable clinical appearance as takotsubo syndrome (TTS) or exist simultaneously, making it challenging for clinicians to treat and manage. Case reports lack consolidated data. We examined SCAD-TTS case reports. AIM: To conduct a systematic review of available case reports on SCAD in order to investigate its potential association with TTS. METHODS: SCAD-associated TTS case reports were reviewed after thoroughly screening PubMed, EMBASE, Scopus, and Google Scholar databases till January 2023. Case reports described demographics, comorbidities, imaging, management, and results. RESULTS: = 6, > 60 years) were elderly (mean age 56.2 ± 9.07 years, range 36-70 years). Canada has 9 cases, United States 3, Australia 3, Sweden 2, Japan, Denmark, and France 1. Only 5 reports identified emotional stressors in these cases while 4 reports showed physical triggers for TTS. Nine had hypertension, 2 had hyperlipidemia, and 1 had prediabetes. 5 patients (25%) smoked. 10 (50%) troponin-positive myocardial infarction patients reported chest discomfort. 11 (55%) of 20 instances had TTS/SCAD. 12 (60%) of 20 patients exhibited ST elevation and 3 (15%) had T wave inversion on electrocardiogram. 19/20 patients had elevated troponin. 9 (45%) of 20 people had apical akinesis with TTS ballooning on cardiac imaging. All 20 exhibited echocardiographic wall motion abnormalities. 19 (95%) of 20 coronary angiography cases had SCAD. 10 of 19 SCAD patients had left anterior descending, 2 diagonal, and 2 left circumflex coronary artery involvement. 7 of 20 patients had left ventricular ejection fraction (LVEF) data. LVEF averaged 38.78 ± 7.35%. 5 (25%) of the 20 cases underwent dual antiplatelet therapy. Three (15%) of 20 cases experienced occasional ectopic ventricular complexes, Mobitz ll AV block, and paroxysmal atrial fibrillation. All 20 cases recovered and survived. CONCLUSION: Given the clinical similarities and challenges in detecting TTS and SCAD, this subset needs more research to raise awareness and reduce morbidity.
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Bhanushali et al. (2023) conducted a systematic review in Spontaneous coronary artery dissection-associated takotsubo syndrome (n=20). Spontaneous coronary artery dissection and takotsubo syndrome was evaluated on Recovery and survival. In a systematic review of 20 case reports of SCAD-associated takotsubo syndrome, 95% of cases had SCAD on coronary angiography and all 20 patients recovered and survived.
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