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

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.