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

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Petur Petursson¹  Björn Redfors¹  Elmir Omerovic¹  Oskar Angerås¹  Sigurdur Thorleifsson¹  Sandeep Jha¹  Annika Ravn‐Fisher¹  Per Tornvall²  Tomas Jernberg³  Christina Ekenbäck⁴  Alexander R. Lyon⁵  Ole Frobert⁶  David Erlinge⁷  Stefan James⁸  Giovanna Sarno⁸  Shams Y‐Hassan⁹ 

[1] Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden;Department of Clinical Science and Education Södersjukhuset Karolinska Institute Stockholm Sweden;Department of Clinical Sciences Danderyd University HospitalKarolinska Institutet Stockholm Sweden;Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine Karolinska Institutet Stockholm Sweden;NIHR Cardiovascular Biomedical Research Unit Royal Brompton Hospital London United Kingdom;The Department of Cardiology Faculty of Health Örebro University Örebro Sweden;The Department of Cardiology Skåne University Hospital Lund Sweden;The Department of Medical Sciences, Cardiology Uppsala University Uppsala Sweden;The Department of Medicine Karolinska University Hospital Huddinge Stockholm Sweden;

关键词: acute heart failure;    cardiogenic shock;    mortality rate;    non–ST‐segment–elevation myocardial infarction;    ST‐segment–elevation myocardial infarction;    Swedish Coronary Angiography and Angioplasty Registry;   

DOI  :  10.1161/JAHA.119.017290

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown