Postdischarge outcome after Takotsubo syndrome compared with patients post-ACS and those without prior CVD: ANZACS-QI 19

Abstract

ObjectiveTakotsubo syndrome (TS) mimics acute coronary syndrome (ACS) but has a distinct pathophysiology. While in-hospital adverse outcomes appear similar to those presenting with an ACS, data on longer term postdischarge risk are conflicting. This study sought to assess the long-term prognosis of patients discharged alive after TS.MethodsThe clinical profile and in-hospital and long-term outcomes were prospectively assessed in consecutive patients with TS. Survival in patients with TS was compared with two representative age-matched and gender-matched comparison cohorts: a hospitalised ACS cohort and a community cohort without known cardiovascular disease (CVD).ResultsTwo hundred and-twenty-five patients with TS (216 women, mean age 63.7±11.8 years) were included. In-hospital mortality was 1.8% and 1.9% for patients with TS and ACS, respectively. Of the 219 patients with TS with postdischarge follow-up, at a mean follow-up of 4.8±3.2 years, there were 19 (8.3%) deaths, 18 of which were from non-cardiac causes. When compared with the cohort without prior CVD, postdischarge patients with TS were at increased mortality risk (HR 2.00, 95% CI 1.26 to 3.17, p=0.003), but mortality in postdischarge patients with ACS was over threefold higher (HR 3.43, 95% CI 2.97 to 3.96, p<0.0001).ConclusionsIn-hospital mortality for patients diagnosed with TS and ACS was similar. However, while postdischarge survivors of TS had a long-term survival which was poorer than for a community-based cohort without known CVD, their survival was better than for postdischarge survivors of an ACS event. Late deaths in patients with TS were almost all from non-cardiac causes.

Incidence, determinants and prognostic relevance of dyspnea at admission in patients with Takotsubo syndrome: results from the international multicenter GEIST registry

“…Hence we hypothesize that, in the vulnerable subset of patients with dyspnea at presentation, comorbidities may act in a synergistic fashion with TTS functional abnormalities, resulting in greater cardiac dysfunction and decompensation during the acute phase, and worse prognosis in the long-term. Accordingly, the prognostic relevance of comorbidities is supported by results of both our and other studies 14 , 35 – 37 , and further corroborated by the fact that long-term mortality in TTS is mainly non-cardiovascular 6 , 10 , 24 , 29 .…”

“…Nonetheless, several complications during in-hospital course and follow up may occur in TTS with an event rate comparable to that observed in patients with acute coronary syndrome (ACS) [4][5][6][7] . However, both short 8,9 and long-term 6,10 prognosis remain quite heterogeneous in TTS, which supports the need of improved risk stratification in order to identify those patients who may most benefit from intensive in-hospital management and long-term clinical follow-up 11 . Dyspnea at presentation is associated with worse prognosis in ACS 12 , and its assessment was able to improve accuracy of a traditional risk stratification model in these patients 13 .…”

Effect of Hypoxia-Induced MicroRNA-210 Expression on Cardiovascular Disease and the Underlying Mechanism

“…Acute coronary syndrome (ACS) is a more urgent and high-risk CVD than atherosclerosis, which can cause acute ischemia and severe damage through blockade of blood flow in cardiovascular tissue [56]. In an animal model of AMI, Hu et al [43] injected a plasmid containing miR-210 into the experimental group.…”

Long‐term prognosis in patients with Takotsubo syndrome

“…Considering from the standpoint of prognosis, personalized treatment strategy and follow‐up are mandatory in TTS. In the All New Zealand Acute Coronary Syndrome Quality Improvement Program, in‐hospital mortality of TTS patients was equivalent to that of patients with acute coronary syndrome, whereas TTS patients had better long‐term survival than acute coronary syndrome patients after discharge. Even in the southern hemisphere, the trend in prognosis was quite similar to that in the northern hemisphere .…”

“…In the All New Zealand Acute Coronary Syndrome Quality Improvement Program, in‐hospital mortality of TTS patients was equivalent to that of patients with acute coronary syndrome, whereas TTS patients had better long‐term survival than acute coronary syndrome patients after discharge. Even in the southern hemisphere, the trend in prognosis was quite similar to that in the northern hemisphere . Accordingly, long‐term prognosis in TTS patients becomes favourable when adequate and accurate treatment is provided in the acute phase.…”