Short- and Long-Term Incidence of Thromboembolic Events in Takotsubo Syndrome as Compared With Acute Coronary Syndrome

Abstract

Thromboembolic events are a common complication in Takotsubo syndrome (TTS). However, their long-term incidence compared with acute coronary syndrome (ACS) is lacking. In-hospital and long-term incidence of thromboembolic events of 138 consecutive patients with TTS were compared with 138 sex- and age-matched patients with ACS. Predictors of events were analyzed. The incidence of thromboembolic events in TTS was 2-fold higher than ACS (21% vs 9%; P < .01) over a mean follow-up of 5 years. Although the left ventricular ejection fraction (LVEF) at event was significantly lower in TTS compared with ACS (38% [9%] vs 54% [11%]; P < .01), the follow-up LVEF was comparable. Patients with TTS suffering from thromboembolic events were more often treated with anticoagulation compared with ACS (44.8% vs 8.3%, P = .03). However, more patients presenting with ACS (100% vs 48.3%; P < .01) were discharged on aspirin. Only elevated C-reactive protein was a predictor of thromboembolic events using multivariate analysis (hazard ratio 1.1, 95% confidence interval, 1.0-1.2; P < .01). In conclusion, the risk of thromboembolic events in TTS was significantly higher than the risk of thromboembolic events in ACS over a mean follow-up of 5 years.

Predictors of thromboembolic events in Takotsubo syndrome: reply

“…The rate of thromboembolic events in our population was substantially lower than that recently observed in a single-centre study by El-Battrawy et al, who reported a prevalence of 13.0% (18 of 138 patients) during hospitalization. 5 Conversely, our findings are largely consistent with the results from the multicentre German Italian Stress Cardiomyopathy (GEIST) Registry, which reported a prevalence of 2.2% (12 of 541 patients). 6 The incidence of stroke at follow-up was not investigated in our study, which considered the occurrence of major adverse cardiac events as the composite study endpoint.…”

Is Takotsubo Syndrome Still a Benign Disease? Complications (and Gender) Make the Difference

“…Prognosis should be evaluated case by case, depending on the presence of concomitant factors. For example, for thromboembolic events as reported by El-Battrawy et al 9 Also, males seem to have a higher mortality risk.…”

“…The incidence of thromboembolic events in TTS was 2-fold higher than for ACS (21% vs 9%; P < .01) over a mean follow-up of 5 years. 9 Although TTS has been generally considered as a benign disease since left ventricular function returns to normal within a short time, contemporary observations have modified this assumption. 10 A recent meta-regression study including 54 studies (>4600 patients) reported a death during admission of 1.8%, and a 3.5% annual all-cause mortality.…”

Current Knowledge and Future Challenges in Takotsubo Syndrome: Part 2—Treatment and Prognosis

“…Time of LV thrombi formation ranges from admission until 2 weeks after. Apical ballooning pattern, left ventricular ejection fraction ≤ 30%, previous vascular disease, increased C-protein levels, troponin-I levels > 10 ng/mL, and a white blood cell count on admission > 10 × 10 3 cells/μL are independent predictors of LV thrombosis [ 28 , 29 , 30 ].…”