Department of Cardiology, Hospital Universitario de La Princesa. Instituto de Investigación Sanitaria Princesa (IIS-IP). CIBER-CV. Universidad Autónoma de Madrid, Madrid.
Department of Cardiology, Hospital Universitario Arnau de Vilanova & Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida.
Coron Artery Dis. 2024 Jan 1;35(1):50-58. doi: 10.1097/MCA.0000000000001304. Epub 2023 Nov 2.
Spontaneous coronary artery dissection (SCAD) and Takotsubo syndrome (TTS) constitute two common causes of nonatherosclerotic acute cardiac syndrome particularly frequent in women. Currently, there is no information comparing long-term clinical outcomes in unselected patients with these conditions.
We compared the baseline characteristics, in-hospital outcomes, and the 12-month and long-term clinical outcomes of two large prospective registries on SCAD and TTS.
A total of 289 SCAD and 150 TTS patients were included; 89% were women. TTS patients were older with a higher prevalence of cardiovascular risk factors. Precipitating triggers were more frequent in TTS patients, while emotional triggers and depressive disorders were more common in the SCAD group. Left ventricular ejection fraction was lower in TTS patients, but SCAD patients showed higher cardiac biomarkers. In-hospital events (43.3% vs. 5.2%, P <0.01) occurred more frequently in TTS patients. TTS patients also presented more frequent major adverse events at 12-month (14.7% vs. 7.1%, HR 5.3, 95% CI: 2.4-11.7, P <0.01) and long-term (median 36 vs. 31 months, P =0.41) follow-up (25.8% vs. 9.6%, HR 4.5, 95% CI: 2.5-8.2, P <0.01). Atrial fibrillation was also more frequent in TTS patients. Moreover, TTS patients presented a higher 12-month and long-term mortality (5.6% vs. 0.7%, P =0.01; and 12.6% vs. 0.7%, P <0.01) mainly driven by noncardiovascular deaths.
Compared to SCAD, TTS patients are older and present more cardiovascular risk factors but less frequent depressive disorder or emotional triggers. TTS patients have a worse in-hospital, mid-term, and long-term prognosis with higher noncardiac mortality than SCAD patients.
自发性冠状动脉夹层（SCAD）和 Takotsubo 综合征（TTS）是两种常见的非动脉粥样硬化性急性心脏综合征的病因，尤其多见于女性。目前，尚无关于这两种疾病未经选择的患者的长期临床结局的信息。
我们比较了两个大型前瞻性 SCAD 和 TTS 注册研究的基线特征、住院期间结局以及 12 个月和长期临床结局。
共纳入 289 例 SCAD 和 150 例 TTS 患者，其中 89%为女性。TTS 患者年龄较大，且具有更多的心血管危险因素。TTS 患者的促发因素更常见，而情绪触发因素和抑郁障碍在 SCAD 组更为常见。TTS 患者的左心室射血分数较低，但 SCAD 患者的心脏生物标志物水平较高。TTS 患者的住院事件（43.3% vs. 5.2%，P<0.01）更常见。在 12 个月（14.7% vs. 7.1%，HR 5.3，95%CI：2.4-11.7，P<0.01）和长期（中位 36 个月 vs. 31 个月，P=0.41）随访中，TTS 患者也更频繁出现主要不良事件（25.8% vs. 9.6%，HR 4.5，95%CI：2.5-8.2，P<0.01）。TTS 患者也更常见心房颤动。此外，TTS 患者的 12 个月和长期死亡率更高（5.6% vs. 0.7%，P=0.01；12.6% vs. 0.7%，P<0.01），主要是由非心血管死亡导致。
与 SCAD 相比，TTS 患者年龄较大，且具有更多的心血管危险因素，但较少出现抑郁障碍或情绪触发因素。TTS 患者的住院期间、中期和长期预后较差，非心脏死亡率高于 SCAD 患者。
