Secondary forms of Takotsubo cardiomyopathy: A whole different prognosis

Núñez-Gil, Iván J ; Almendro-Delia, Manuel ; Andrés, Mireia ; Sionis, Alessandro ; Martin, Ana ; Bastante, Teresa ; Córdoba-Soriano, Juan G ; Linares, José A (Universidad de Zaragoza) ; González Sucarrats, Silvia ; Sánchez-Grande-Flecha, Alejandro ; Fabregat-Andrés, Oscar ; Pérez, Beatriz ; Escudier-Villa, Juan M ; Martin-Reyes, Roberto ; Pérez-Castellanos, Alberto ; Rueda Sobella, Ferrán ; Cambeiro, Cristina ; Piqueras-Flores, Jesús ; Vidal-Perez, Rafael ; Bodí, Vicente ; García de la Villa, Bernardo ; Corbí-Pascua, Miguel ; Biagioni, Corina ; Mejía-Rentería, Hernán D ; Feltes, Gisela ; Barrabés, José ;

Resumen: Background
Takotsubo syndrome (TKS) usually mimics an acute coronary syndrome. However, several clinical forms have been reported. Our aim was to assess if different stressful triggers had prognostic influence on TKS, and to establish a working classification.

Methods
We performed an analysis including patients with TKS between 2003–2013 from our prospective local database and the RETAKO National Registry, fulfilling Mayo criteria. Patients were divided in two groups regarding their potential triggers: (a) none/psychic stress as ‘primary forms’ and (b) physical factors (asthma, surgery, trauma, etc.) as ‘secondary forms’.

Results
Finally, 328 patients were included, 90.2% women, with a mean age of 69.7 years. Patients were divided into primary TKS (n=265) and 63 secondary TKS groups. Age, gender, previous functional class and cardiovascular risk profile displayed no differences between groups before admission. However, primary-TKS patients suffered a main complaint of chest pain (89.4% vs 50.7%, p<0.0001) with frequent vegetative symptoms. Regarding treatment before admission, there were no differences either. During admission, differences were related to more intensive antithrombotic and anxiolytic drug use in the primary TKS group. Inotropic and mechanical ventilation use was higher in the secondary cohort. After discharge, a more frequent prescription of beta-blockers and statins in primary-TKS patients was seen. Secondary forms displayed more in-hospital stay and evolutive complications: death (hazard ratio (HR): 3.41; 95% confidence interval (CI): 1.14–10.16, p=0.02), combined event variable (MACE) (HR: 1.61; 95% CI: 1.01–2.6, p=0.04) and recurrences (HR: 1.85; 95% CI: 1.06–3.22, p=0.02).

Conclusion
Secondary TKS could present or mark worse short and long-term prognoses in terms of mortality, recurrences and readmissions. We propose a simple working nomenclature for TKS.

Idioma: Inglés

DOI: 10.1177/2048872615589512

Año: 2015

Publicado en: EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 5, 4 (2015), 308-316
ISSN: 2048-8726

Factor impacto SCIMAGO: 1.322 - Cardiology and Cardiovascular Medicine (Q1) - Medicine (miscellaneous) (Q1) - Critical Care and Intensive Care Medicine (Q1)

Tipo y forma: Article (Published version)

Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)