Key result
Takotsubo syndrome linked to ~40% lower 30-day mortality than STEMI but higher risk than NSTEMI.
Why the study?
Takotsubo syndrome is a potentially life-threatening acute cardiac syndrome with a clinical presentation similar to myocardial infarction, but its natural history, management, and outcomes remain incompletely understood.
Does Takotsubo syndrome have a different 30-day mortality risk compared to STEMI and NSTEMI in patients undergoing coronary angiography?
Cohort (n=117,720)
Yes
Does Takotsubo syndrome have a different 30-day mortality risk compared to STEMI and NSTEMI in patients undergoing coronary angiography?
Hazard Ratio: 0.6 (95% CI 0.48–0.76)
p-value: p=<0.001
Takotsubo syndrome carries a 30-day mortality risk that is lower than STEMI but higher than NSTEMI, with smoking identified as an independent predictor of mortality.
TS mortality risk lies between STEMI and NSTEMI with similar acute HF rates to STEMI; leaves open tailored risk stratification and management pending prospective trials.
Background Takotsubo syndrome (TS) is a potentially life‐threatening acute cardiac syndrome with a clinical presentation similar to myocardial infarction and for which the natural history, management, and outcome remain incompletely understood. Our aim was to assess the relative short‐term mortality risk of TS, ST‐segment–elevation myocardial infarction (STEMI), and non‐STEMI (NSTEMI) and to identify predictors of in‐hospital complications and poor prognosis in patients with TS. Methods and Results This is an observational cohort study based on the data from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry). We included all patients (n=117 720) who underwent coronary angiography in Sweden attributed to TS (N=2898 [2.5%]), STEMI (N=48 493 [41.2%]), or NSTEMI (N=66 329 [56.3%]) between January 2009 and February 2018. We compared patients with TS to those with NSTEMI or STEMI. The primary end point was all‐cause mortality at 30 days. Secondary outcomes were acute heart failure (Killip Class ≥2) and cardiogenic shock (Killip Class 4) at the time of angiography. Patients with TS were more often women compared with patients with STEMI or NSTEMI. TS was associated with unadjusted and adjusted 30‐day mortality risks lower than STEMI (adjusted hazard ratio [adjHR], 0.60; 95% CI, 0.48–0.76; P <0.001), but higher than NSTEMI (adjHR, 2.70; 95% CI, 2.14–3.41; P <0.001). Compared with STEMI, TS was associated with a similar risk of acute heart failure (adjHR, 1.26; 95% CI, 0.91–1.76; P =0.16) but a lower risk of cardiogenic shock (adjHR, 0.55; 95% CI, 0.34–0.89; P =0.02). The relative 30‐day mortality risk for TS versus STEMI and NSTEMI was higher for smokers than nonsmokers (adjusted P interaction STEMI=0.01 and P interaction NSTEMI=0.01). Conclusions The 30‐day mortality rate in TS was higher than in NSTEMI but lower than STEMI despite a similar risk of acute heart failure in TS and STEMI. Among patients with TS, smoking was an independent predictor of mortality.
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A 2021 study conducted a cohort in Takotsubo syndrome, STEMI, and NSTEMI (n=117,720). Takotsubo syndrome vs. STEMI and NSTEMI was evaluated on all-cause mortality at 30 days (HR 0.60, 95% CI 0.48-0.76, p=<0.001). Takotsubo syndrome was associated with a lower 30-day mortality risk than STEMI (HR 0.60; 95% CI 0.48-0.76) but a higher risk than NSTEMI (HR 2.70; 95% CI 2.14-3.41).
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