Short-term outcomes in patients with Takotsubo cardiomyopathy: an age- and gender matched comparison to patients with acute coronary syndrome

Abstract

Purpose: Clinical presentation of Takotsubo cardiomyopathy (TTC) mimics acute coronary syndromes (ACS). While ACS is a life-threatening condition, TTC is usually regarded as a non-fatal cardiomyopathy with a favorable long-term outcome. Severe complications have been reported in patients with TTC in the acute stage, however systematic data are lacking. Therefore, the aim of the present study was to assess the short-term outcome in patients with TTC compared to patients with ACS. Methods: 584 patients were included in the present study. 292 consecutive patients with TTC were identified according to the Mayo Clinic Diagnostic criteria and compared to an age- and gender matched control population with ACS. Medical records were evaluated from the International Takotsubo-Registry at the University Hospital of Zurich and the Zurich Acute-Coronary-Syndrome Registry from 2002-2012. Clinical profile and in-hospital mortality as well as cardiogenic shock rate were analyzed. Results: On admission, patients with TTC presented with a significantly higher heart rate (p<0.001) and lower systolic blood pressure compared to patients with ACS (p=0.02). In addition, left ventricular ejection fraction was significantly reduced (p<0.001) and end-diastolic pressure elevated (p=0.006) in comparison to patients with ACS. We did not observe any differences in resuscitation and catecholamine administration between the two groups on acute presentation (p=n.s). The prevalence of cardiogenic shock (TTC 12% vs. ACS 10.3%, p=n.s.) and death (TTC 4.1% vs. ACS 4.1%, p=n.s.) were not significantly different between the two groups. Conclusion: Our study demonstrates that TTC is a potentially life-threatening disease with the same short-term outcomes compared to patients with ACS. Therefore, intensive monitoring and early treatment must be considered in such patients.