Spontaneous coronary artery dissection and Takotsubo syndrome: comparison of baseline clinical and angiographic characteristics and in-hospital outcomes. Issue 6 (12th November 2020)

• Record Type: Journal Article
• Authors: Salamanca, Jorge; García-Guimaraes, Marcos; Camacho-Freire, Santiago Jesús; Ojeda, Soledad; Veiga, Gabriela; Jiménez-Valero, Santiago; Hernández-Antolín, Rosana; Trillo, Ramiro; Velázquez, Maite; Cortes, Carlos; Gutiérrez-Barrios, Alejandro; Franco-Pelaez, Juan Antonio; Lezcano-Pertejo, Cristina; Diez-Delhoyo, Felipe; Gamarra, Alvaro; Aguilar, Rio; Díez-Villanueva, Pablo; Bastante, Teresa; Alfonso, Fernando
• Is Part Of: Coronary artery disease. Volume 32:Issue 6(2021)
• Page Start: 509
• Page End: 516
• Publication Date: 2020-11-12
• Subjects: acute coronary syndrome -- coronary artery disease -- spontaneous coronary artery dissection -- Takotsubo syndrome; Coronary heart disease -- Periodicals; Coronary Disease -- Indexes; Coronary Disease -- Periodicals; 616.123005
• DOI: 10.1097/MCA.0000000000000984
• Languages: English
• ISSNs: 0954-6928

Abstract

Abstract : 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.