Looi Jen-Li, Verryt Toby, McLeod Peter, Chan Christina, Pemberton James, Webster Mark, To Andrew, Lee Mildred, Kerr Andrew J
Department of Cardiology, Middlemore Hospital, Otahuhu, Auckland.
Department of Cardiology, Christchurch Hospital, Christchurch.
N Z Med J. 2020 Aug 21;133(1520):73-82.
Takotsubo syndrome (TS) mimics acute coronary syndrome but has a distinct pathophysiology. This study aimed to compare and contrast the clinical presentation, management and outcomes of patients with TS in five large New Zealand hospitals.
We identified 632 consecutive patients presenting to the five major tertiary hospitals in New Zealand (Middlemore Hospital, Auckland City Hospital, North Shore Hospital, Christchurch Hospital and Dunedin Hospital) between January 2006 and June 2018 and obtained clinical, laboratory, electrocardiography, echocardiography, coronary angiography and long-term follow-up data.
Six hundred and thirty-two consecutive patients with TS (606 women, mean age 65.0+11.1 years) were included. An associated stressor was identified in two-thirds of patients, and emotional triggers were more frequent than physical triggers (62.9% and 37.1%, respectively). Overall, 12.7% of patient had depression and 11.7% anxiety but this was more common in patients from Christchurch Hospital (20.4% and 23.4%, respectively). The in-hospital mortality among the five hospitals ranges between 0 to 2.0%. The mean follow-up was 4.9+3.4 years (median 4.4 years). Fifty-four people died post-discharge, all but one from a non-cardiac cause. Forty patients had recurrent TS. Mortality post-discharge (p=0.63) and TS recurrence (p=0.38) did not differ significantly among the five hospitals.
In this large New Zealand TS cohort, the clinical characteristics and presentation were similar among the five hospitals. A subset of patients had a complicated in-hospital course, but late deaths were almost all from non-cardiac causes and recurrence was infrequent. Mortality post-discharge and recurrence was similar between the hospitals.
应激性心肌病（TS）酷似急性冠脉综合征，但有着独特的病理生理学机制。本研究旨在比较和对比新西兰五家大型医院中TS患者的临床表现、治疗及预后情况。
我们确定了2006年1月至2018年6月期间在新西兰五家主要的三级医院（米德尔莫尔医院、奥克兰市医院、北岸医院、克赖斯特彻奇医院和达尼丁医院）连续就诊的632例患者，并获取了其临床、实验室、心电图、超声心动图、冠状动脉造影及长期随访数据。
纳入632例连续的TS患者（606例女性，平均年龄65.0±11.1岁）。三分之二的患者确定存在相关应激源，情绪触发因素比身体触发因素更常见（分别为62.9%和37.1%）。总体而言，12.7%的患者有抑郁症，11.7%有焦虑症，但在克赖斯特彻奇医院的患者中更为常见（分别为20.4%和23.4%）。五家医院的院内死亡率在0至2.0%之间。平均随访时间为4.9±3.4年（中位数4.4年）。54人出院后死亡，除1人外均死于非心脏原因。40例患者复发TS。五家医院出院后死亡率（p=0.63）和TS复发率（p=0.38）差异无统计学意义。
在这个大型的新西兰TS队列中，五家医院的临床特征和表现相似。一部分患者住院过程复杂，但晚期死亡几乎均由非心脏原因导致，且复发不常见。各医院出院后死亡率和复发率相似。
