Shall be takotsubo tear apart from working diagnosis of myocardial infarction with non-obstructive coronary arteries?. (25th November 2020)

• Record Type: Journal Article
• Authors: Lopez-Pais, J; Izquierdo Coronel, B; Raposeiras-Roubin, S; Alvarez Rodriguez, L; Vedia, O; Almendro-Delia, M; Uribarri, A; Galan Gil, D; Espinosa Pascual, M.J; Martin De Miguel, I; Garcia Acuna, J.M; Iniguez Romo, A; Alonso Martin, J.J; Gonzalez Juanatey, J.R; Nunez Gil, I
• Is Part Of: European heart journal. Volume 41:(2020)Supplement 2
• Publication Date: 2020-11-25
• Subjects: Acute Coronary Syndromes: Tako-Tsubo Cardiomyopathy; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/ehjci/ehaa946.1815
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Aims: Whether Takotsubo syndrome (TTS) should be classified within myocardial infarction with non-obstructive coronary arteries (MINOCA) is still controversial. The aim of this work is to evaluate main differences between TTS and non-TTS MINOCA. Methods and results: A cohort study based on two prospective registries: TTS from the RETAKO registry (N:1055) and non-TTS MINOCA patients from contemporary records of acute myocardial infarction from 5 national centres (N:1080). Definitions and management recommended by the ESC were used. Survival analysis was based on Cox regression; propensity score matching was created to adjust prognostic variables. TTS were more often women (85.9% vs. 51.9%; p<0.001) and older (69.4±12.5 vs. 64.5±14.1 years; p<0.001). Atrial fibrillation was more frequent in non-TTS MINOCA (10.4% vs. 14.4%; p 0.007). Psychiatric disorders were more prevalent in TTS (15.5% vs. 10.2%, p<0.001). In-hospital mortality and complications were higher in TTS: 3.4 vs 1.8%, (p 0.015) and 25.8% vs. 11.5%, (p<0.001). Median follow-up was 32.4 months; TTS had less major adverse cardiovascular events (MACE): Hazard Ratio (HR) 0.59; 95% confidence interval (CI) 0.42 to 0.83. There were no differences in total mortality (HR 0.87; CI: 0.64 to 1.19), but TTS had lower cardiovascular mortality (HR 0.58; CI: 0.35 to 0.98). Conclusions: TTS has a different patient's profile and a more aggressive acute phase than the rest of MINOCA. However, its long-term cardiovascular prognosis is better. These results support that TTS should be considered a distinct entity with unique characteristics and prognosis. Funding Acknowledgement: Type of funding source: None