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Short-and long-term clinical outcomes for patients with takotsubo syndrome and patients with myocardial infarction : A report from the swedish coronary angiography and angioplasty registry

Redfors, Björn ; Jha, Sandeep ; Thorleifsson, Sigurdur ; Jernberg, Tomas ; Angeras, Oskar ; Frobert, Ole ; Petursson, Petur ; Tornvall, Per ; Sarno, Giovanna and Ekenback, Christina , et al. (2021) In Journal of the American Heart Association 10(17).
Abstract

BACKGROUND: Takotsubo syndrome (TS) is a potentially life-threatening acute cardiac syndrome with a clinical presentation similar to myocardial infarction and for which the natural history, management, and outcome remain incompletely understood. Our aim was to assess the relative short-term mortality risk of TS, ST-segment–elevation myocardial infarction (STEMI), and non-STEMI (NSTEMI) and to identify predictors of in-hospital complications and poor prognosis in patients with TS. METHODS AND RESULTS: This is an observational cohort study based on the data from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry). We included all patients (n=117 720) who underwent coronary angiography in Sweden attributed to TS (N=2898... (More)

BACKGROUND: Takotsubo syndrome (TS) is a potentially life-threatening acute cardiac syndrome with a clinical presentation similar to myocardial infarction and for which the natural history, management, and outcome remain incompletely understood. Our aim was to assess the relative short-term mortality risk of TS, ST-segment–elevation myocardial infarction (STEMI), and non-STEMI (NSTEMI) and to identify predictors of in-hospital complications and poor prognosis in patients with TS. METHODS AND RESULTS: This is an observational cohort study based on the data from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry). We included all patients (n=117 720) who underwent coronary angiography in Sweden attributed to TS (N=2898 [2.5%]), STEMI (N=48 493 [41.2%]), or NSTEMI (N=66 329 [56.3%]) between January 2009 and February 2018. We compared patients with TS to those with NSTEMI or STEMI. The primary end point was all-cause mortality at 30 days. Secondary outcomes were acute heart failure (Killip Class ≥2) and cardiogenic shock (Killip Class 4) at the time of angiography. Patients with TS were more often women compared with patients with STEMI or NSTEMI. TS was associated with unadjusted and adjusted 30-day mortality risks lower than STEMI (adjusted hazard ratio [adjHR], 0.60; 95% CI, 0.48–0.76; P<0.001), but higher than NSTEMI (adjHR, 2.70; 95% CI, 2.14–3.41; P<0.001). Compared with STEMI, TS was associated with a similar risk of acute heart failure (adjHR, 1.26; 95% CI, 0.91–1.76; P=0.16) but a 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 NSTEMI was higher for smokers than nonsmokers (adjusted P interaction STEMI=0.01 and P interaction NSTEMI=0.01). CONCLUSIONS: The 30-day mortality rate in TS was higher than in NSTEMI but lower than STEMI despite a similar risk of acute heart failure in TS and STEMI. Among patients with TS, smoking was an independent predictor of mortality.

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type
Contribution to journal
publication status
published
subject
keywords
Acute heart failure, Cardiogenic shock, Mortality rate, Non–ST-segment–elevation myocardial infarction, ST-segment–elevationmyocardial infarction, Swedish Coronary Angiography and Angioplasty Registry, Takotsubo syndrome
in
Journal of the American Heart Association
volume
10
issue
17
article number
e017290
publisher
Wiley-Blackwell
external identifiers
  • scopus:85116171677
  • pmid:34465127
ISSN
2047-9980
DOI
10.1161/JAHA.119.017290
language
English
LU publication?
no
additional info
Publisher Copyright: © 2021 The Authors.
id
9601cbf2-d054-4fb8-b6cd-3000f4d7444d
date added to LUP
2021-10-21 12:00:49
date last changed
2024-06-16 21:22:25
@article{9601cbf2-d054-4fb8-b6cd-3000f4d7444d,
  abstract     = {{<p>BACKGROUND: Takotsubo syndrome (TS) is a potentially life-threatening acute cardiac syndrome with a clinical presentation similar to myocardial infarction and for which the natural history, management, and outcome remain incompletely understood. Our aim was to assess the relative short-term mortality risk of TS, ST-segment–elevation myocardial infarction (STEMI), and non-STEMI (NSTEMI) and to identify predictors of in-hospital complications and poor prognosis in patients with TS. METHODS AND RESULTS: This is an observational cohort study based on the data from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry). We included all patients (n=117 720) who underwent coronary angiography in Sweden attributed to TS (N=2898 [2.5%]), STEMI (N=48 493 [41.2%]), or NSTEMI (N=66 329 [56.3%]) between January 2009 and February 2018. We compared patients with TS to those with NSTEMI or STEMI. The primary end point was all-cause mortality at 30 days. Secondary outcomes were acute heart failure (Killip Class ≥2) and cardiogenic shock (Killip Class 4) at the time of angiography. Patients with TS were more often women compared with patients with STEMI or NSTEMI. TS was associated with unadjusted and adjusted 30-day mortality risks lower than STEMI (adjusted hazard ratio [adjHR], 0.60; 95% CI, 0.48–0.76; P&lt;0.001), but higher than NSTEMI (adjHR, 2.70; 95% CI, 2.14–3.41; P&lt;0.001). Compared with STEMI, TS was associated with a similar risk of acute heart failure (adjHR, 1.26; 95% CI, 0.91–1.76; P=0.16) but a 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 NSTEMI was higher for smokers than nonsmokers (adjusted P interaction STEMI=0.01 and P interaction NSTEMI=0.01). CONCLUSIONS: The 30-day mortality rate in TS was higher than in NSTEMI but lower than STEMI despite a similar risk of acute heart failure in TS and STEMI. Among patients with TS, smoking was an independent predictor of mortality.</p>}},
  author       = {{Redfors, Björn and Jha, Sandeep and Thorleifsson, Sigurdur and Jernberg, Tomas and Angeras, Oskar and Frobert, Ole and Petursson, Petur and Tornvall, Per and Sarno, Giovanna and Ekenback, Christina and Ravn-Fisher, Annika and Y-Hassan, Shams and Lyon, Alexander R. and James, Stefan and Erlinge, David and Omerovic, Elmir}},
  issn         = {{2047-9980}},
  keywords     = {{Acute heart failure; Cardiogenic shock; Mortality rate; Non–ST-segment–elevation myocardial infarction; ST-segment–elevationmyocardial infarction; Swedish Coronary Angiography and Angioplasty Registry; Takotsubo syndrome}},
  language     = {{eng}},
  number       = {{17}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Journal of the American Heart Association}},
  title        = {{Short-and long-term clinical outcomes for patients with takotsubo syndrome and patients with myocardial infarction : A report from the swedish coronary angiography and angioplasty registry}},
  url          = {{http://dx.doi.org/10.1161/JAHA.119.017290}},
  doi          = {{10.1161/JAHA.119.017290}},
  volume       = {{10}},
  year         = {{2021}},
}