Differences Between Takotsubo and the Working Diagnosis of Myocardial Infarction With Nonobstructive Coronary Arteries
Javier López‐País, B Izquierdo Coronel, Sergio Raposeiras‐Roubín, Leyre Álvarez Rodríguez, Óscar Vedia, Manuel Almendro‐Delia, Alessandro Sionís, Agustín Martín‐García, Aitor Uribarri, Emilia Blanco‐Ponce, Irene Martín de Miguel, Emad Abu‐Assi, D Galan Gil, Manuela Sestayo‐Fernández, M J Espinosa Pascual, Rosa María Agra-Bermejo, Diego López‐Otero, José María García‐Acuña, Joaquín Jesús Alonso Martín, José Ramón González‐Juanatey, M A Perez De Juan Romero, Iván J. Núñez‐Gil
Abstract
Aim Whether Takotsubo syndrome (TTS) should be classified within myocardial infarction with non-obstructive coronary arteries (MINOCAs) is still controversial. The aim of this work was to evaluate the main differences between TTS and non-TTS MINOCAs. Methods and Results A cohort study based on two prospective registries: TTS from the RETAKO registry ( N :1,015) and patients with non-TTS MINOCAs from contemporary records of acute myocardial infarction from five 5 national centers ( N :1,080). Definitions and management recommended by the ESC were used. Survival analysis was based on the Cox regression analysis; propensity score matching (PS) was created to adjust prognostic variables. Takotsubo syndrome were more often women (85.9 vs. 51.9%; p < 0.001) and older (69.4 ± 12.5 vs. 64.5 ± 14.1 years; p < 0.001). Atrial fibrillation (AF) was more frequent in non-TTS MINOCAs (10.4 vs. 14.4%; p = 0.007). Psychiatric disorders were more prevalent in TTS (15.5 vs. 10.2%, p < 0.001). In-hospital mortality and complications were higher in TTS: 3.4 vs. 1.8%, ( p = 0.015), and 25.8 vs. 11.5%, ( p < 0.001). Global mortality before PS matching was 16.1% in non-TTS MINOCAs and 8.1% in TTS. Median follow-up was 32.4 months; after PS matching, TTS had fewer major adverse cardiovascular events (MACEs): hazard ratio (HR) 0.59; 95% CI 0.42–0.83. There were no differences in global mortality (HR 0.87; CI: 0.64–1.19), but TTS had lower cardiovascular mortality (HR 0.58; CI: 0.35–0.98). Conclusion Compared to the rest of MINOCAs, TTS presents a different patient profile and a more aggressive acute phase. However, its long-term cardiovascular prognosis is better. These results support that TTS should be considered a separate entity with unique characteristics and prognosis.