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Short- and Long-Term Clinical Outcomes for Patients with Takotsubo Syndrome Versus Myocardial Infarction: A Report from the Swedish Coronary Angiography and Angioplasty Registry

35 Pages Posted: 30 Dec 2018

See all articles by Björn Redfors

Björn Redfors

University of Gothenburg - Department of Cardiology

Sandeep Jha

University of Gothenburg - Department of Cardiology

Sigurdur Thorleifsson

University of Gothenburg - Department of Cardiology

Tomas Jernberg

Karolinska Institutet

Oskar Angerås

University of Gothenburg - Department of Cardiology

Ole Frobert

Örebro University

Petur Petrusson

University of Gothenburg - Department of Cardiology

Per Tornvall

Södra University Hospital

Giovanna Sarno

Uppsala University

Christina Ekenbäck

Södra University Hospital

Annika Ravn-Fisher

University of Gothenburg - Department of Cardiology

Shams Younis-Hassan

Karolinska Institutet - Department of Medicine

Alexander Lyon

Imperial College London - National Heart and Lung Institute

Stefan James

Uppsala University

David Erlinge

Lund University - Skåne University Hospital

Elmir Omerovic

University of Gothenburg - Department of Cardiology

More...

Abstract

Aim: The takotsubo syndrome (TS) is a life-threatening acute cardiac syndrome that is difficult to distinguish from myocardial infarction (MI) and for which the natural history, management and outcome remain incompletely understood. The aims of this study were to assess the relative short- and long-term mortality risk of TS versus ST-elevation MI (STEMI) and non STEMI (NSTEMI) and to identify predictors of in-hospital complications and worse prognosis among patients with TS.

Methods and Results: Using the nationwide Swedish Angiography and Angioplasty Registry (SCAAR) we identified 117,720 patients who underwent coronary angiography due to TS (N=2,898 [2.5%]), STEMI (N=48,493 [41.2%]) or NSTEMI (N=66,329 [56.3%]) in Sweden between January 2009 and February 2018. Patients with TS were more likely to be women than patients with STEMI or NSTEMI. TS was associated with unadjusted and adjusted 30-day mortality risks that were lower than in STEMI (adjusted hazard ratio [adjHR] 0.60, 95% confidence interval [CI]0.48-0.76, p<0.001), but higher than in NSTEMI (adjHR 2.70, 95% CI 2.14-3.41, p<0.001). Compared to STEMI TS was associated with similar risk of acute heart failure (adjHR 1.26, 95% CI 0.91-1.76, p=0.16) but lower risk of cardiogenic shock (adjHR 0.55, 95% CI 0.34-0.89, p=0.02). The relative 30-day mortality risk for TS versus STEMI and STEMI were higher for smokers than non-smokers (adjusted pinteractionSTEMI=0.01 and pinteractionNSTEMI=0.01).

Conclusion: Thirty-day mortality in TS was higher than in NSTEMI but lower than in STEMI, despite a similar risk of acute heart failure in TS and STEMI. Among patients with TS, smoking was an independent predictor of mortality.

Funding: The study was financed by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement, Swedish Research Council and Swedish Heart and Lung Foundation.

Declaration of Interests: The authors declare no competing interest in relation to the content of the paper.

Ethical Approval Statement: The study was approved by the ethics committee at the University of Gothenburg.

Suggested Citation

Redfors, Björn and Jha, Sandeep and Thorleifsson, Sigurdur and Jernberg, Tomas and Angerås, Oskar and Frobert, Ole and Petrusson, Petur and Tornvall, Per and Sarno, Giovanna and Ekenbäck, Christina and Ravn-Fisher, Annika and Younis-Hassan, Shams and Lyon, Alexander and James, Stefan and Erlinge, David and Omerovic, Elmir, Short- and Long-Term Clinical Outcomes for Patients with Takotsubo Syndrome Versus Myocardial Infarction: A Report from the Swedish Coronary Angiography and Angioplasty Registry (November 27, 2018). Available at SSRN: https://ssrn.com/abstract=3294111 or http://dx.doi.org/10.2139/ssrn.3294111

Björn Redfors

University of Gothenburg - Department of Cardiology

PO Box 400
Göteborg, SE405 30
Sweden

Sandeep Jha

University of Gothenburg - Department of Cardiology

PO Box 400
Göteborg, SE405 30
Sweden

Sigurdur Thorleifsson

University of Gothenburg - Department of Cardiology

PO Box 400
Göteborg, SE405 30
Sweden

Tomas Jernberg

Karolinska Institutet

Granits väg 4
Solna, Stockholm 17171
Sweden

Oskar Angerås

University of Gothenburg - Department of Cardiology

PO Box 400
Göteborg, SE405 30
Sweden

Ole Frobert

Örebro University

Fakultetsgatan 1
SE-701 82
Örebro, 70210
Sweden

Petur Petrusson

University of Gothenburg - Department of Cardiology

PO Box 400
Göteborg, SE405 30
Sweden

Per Tornvall

Södra University Hospital

Stockholm
Sweden

Giovanna Sarno

Uppsala University

Box 513
Uppsala, 751 20
Sweden

Christina Ekenbäck

Södra University Hospital

Stockholm
Sweden

Annika Ravn-Fisher

University of Gothenburg - Department of Cardiology

PO Box 400
Göteborg, SE405 30
Sweden

Shams Younis-Hassan

Karolinska Institutet - Department of Medicine

Sweden

Alexander Lyon

Imperial College London - National Heart and Lung Institute

Guy Scadding Building, Cale Street
London, SW3 6LY
United Kingdom

Stefan James

Uppsala University

Box 513
Uppsala, 751 20
Sweden

David Erlinge

Lund University - Skåne University Hospital

Malmö
Sweden

Elmir Omerovic (Contact Author)

University of Gothenburg - Department of Cardiology ( email )

PO Box 400
Göteborg, SE405 30
Sweden

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