Background: Prognosis of Takotsubo syndrome (TTS) remains controversial due to scarcity of available data. Additionally, the effect of the triggering factors remains elusive. Objectives: This study compared prognosis between TTS and acute coronary syndrome (ACS) patients and investigated short- and long-term outcomes in TTS based on different triggers. Methods: Patients with TTS were enrolled from the International Takotsubo Registry. Long-term mortality of patients with TTS was compared to an age- and sex-matched cohort of patients with ACS. In addition, short- and long-term outcomes were compared between different groups according to triggering conditions. Results: Overall, TTS patients had a comparable long-term mortality risk with ACS patients. Of 1,613 TTS patients, an emotional trigger was detected in 485 patients (30%). Of 630 patients (39%) related to physical triggers, 98 patients (6%) had acute neurologic disorders, while in the other 532 patients (33%), physical activities, medical conditions, or procedures were the triggering conditions. The remaining 498 patients (31%) had no identifiable trigger. TTS patients related to physical stress showed higher mortality rates than ACS patients during long-term follow-up, whereas patients related to emotional stress had better outcomes compared with ACS patients. Conclusions: Overall, TTS patients had long-term outcomes comparable to age- and sex-matched ACS patients. Also, we demonstrated that TTS can either be benign or a life-threating condition depending on the inciting stress factor. We propose a new classification based on triggers, which can serve as a clinical tool to predict short- and long-term outcomes of TTS. (International Takotsubo Registry [InterTAK Registry]; NCT01947621)
Ghadri, J., Kato, K., Cammann, V., Gili, S., Jurisic, S., Di Vece, D., Candreva, A., Ding, K., Micek, J., Szawan, K., Bacchi, B., Bianchi, R., Levinson, R., Wischnewsky, M., Seifert, B., Schlossbauer, S., Citro, R., Bossone, E., Münzel, T., Knorr, M., Heiner, S., D'Ascenzo, F., Franke, J., Sarcon, A., Napp, L., Jaguszewski, M., Noutsias, M., Katus, H., Burgdorf, C., Schunkert, H., Thiele, H., Bauersachs, J., Tschöpe, C., Pieske, B., Rajan, L., Michels, G., Pfister, R., Cuneo, A., Jacobshagen, C., Hasenfuß, G., Karakas, M., Koenig, W., Rottbauer, W., Said, S., Braun-Dullaeus, R., Banning, A., Cuculi, F., Kobza, R., Fischer, T., Vasankari, T., Airaksinen, K., Opolski, G., Dworakowski, R., Maccarthy, P., Kaiser, C., Osswald, S., Galiuto, L., Crea, F., Dichtl, W., Empen, K., Felix, S., Delmas, C., Lairez, O., El-Battrawy, I., Akin, I., Borggrefe, M., Horowitz, J., Kozel, M., Tousek, P., Widimský, P., Gilyarova, E., Shilova, A., Gilyarov, M., Winchester, D., Ukena, C., Bax, J., Prasad, A., Böhm, M., Lüscher, T., Ruschitzka, F., Templin, C., Long-Term Prognosis of Patients With Takotsubo Syndrome, <<JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY>>, 2018; 72 (8): 874-882. [doi:10.1016/j.jacc.2018.06.016] [http://hdl.handle.net/10807/126515]
Long-Term Prognosis of Patients With Takotsubo Syndrome
Galiuto, Leonarda;Crea, Filippo;
2018
Abstract
Background: Prognosis of Takotsubo syndrome (TTS) remains controversial due to scarcity of available data. Additionally, the effect of the triggering factors remains elusive. Objectives: This study compared prognosis between TTS and acute coronary syndrome (ACS) patients and investigated short- and long-term outcomes in TTS based on different triggers. Methods: Patients with TTS were enrolled from the International Takotsubo Registry. Long-term mortality of patients with TTS was compared to an age- and sex-matched cohort of patients with ACS. In addition, short- and long-term outcomes were compared between different groups according to triggering conditions. Results: Overall, TTS patients had a comparable long-term mortality risk with ACS patients. Of 1,613 TTS patients, an emotional trigger was detected in 485 patients (30%). Of 630 patients (39%) related to physical triggers, 98 patients (6%) had acute neurologic disorders, while in the other 532 patients (33%), physical activities, medical conditions, or procedures were the triggering conditions. The remaining 498 patients (31%) had no identifiable trigger. TTS patients related to physical stress showed higher mortality rates than ACS patients during long-term follow-up, whereas patients related to emotional stress had better outcomes compared with ACS patients. Conclusions: Overall, TTS patients had long-term outcomes comparable to age- and sex-matched ACS patients. Also, we demonstrated that TTS can either be benign or a life-threating condition depending on the inciting stress factor. We propose a new classification based on triggers, which can serve as a clinical tool to predict short- and long-term outcomes of TTS. (International Takotsubo Registry [InterTAK Registry]; NCT01947621)
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