title: Tako-tsubo cardiomyopathy and coronary artery disease: a possible association.
abstract: BACKGROUND
  In the medical literature, several cases of Tako-tsubo cardiomyopathy (TTC) with coronary artery disease (CAD) have been reported, and in clinical practice, several typical TTC cases show relevant stenoses of the coronary arteries spatially unrelated to the dysfunctional myocardium.
  
  
  OBJECTIVE
  This study aimed to evaluate the prevalence, clinical characteristics, and outcome of patients with TTC and relevant CAD in a large multicenter database.
  
  
  METHODS
  In 26 centers, 450 patients admitted with a diagnosis of TTC underwent coronary angiography within 48 h of hospital admission and were included prospectively in the Tako-tsubo Italian Network Registry.
  
  
  RESULTS
  Overall, 43 (9.6%) patients had at least one relevant (≥50%) coronary stenosis not supplying the dysfunctional myocardium, whereas 407 patients (90.4%) had irrelevant stenosis or angiographically normal coronary arteries. TTC patients with relevant CAD were more likely to be older in age, to have diabetes, a familial history of CAD, and acute functional mitral regurgitation compared with those without relevant CAD. At the 6-month follow-up, the incidence of death, TTC recurrence, and rehospitalization rates in patients with and without relevant CAD were similar. On multivariable Cox analysis, an independent predictor of death was the Charlson Comorbidity Index, whereas the presence of CAD did not influence the mid-term outcome significantly.
  
  
  CONCLUSIONS
  The presence of CAD is a rather common finding in a large proportion of patients with TTC. Thus, when the stenotic artery does not supply the dysfunctional myocardium or when the extent of dysfunctional myocardium is wider than the territory of distribution supplied by a single stenotic coronary artery, the presence of angiographically relevant CAD should not be considered an exclusion criterion for TTC.
authors.affiliation: Department of Cardiology, Careggi Hospital, Florence, Italy. parodiguido@gmail.com
authors.forename: Guido
authors.initials: G
authors.lastname: Parodi
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Citro
authors.forename: Benedetta
authors.initials: B
authors.lastname: Bellandi
authors.forename: Stefano
authors.initials: S
authors.lastname: Del Pace
authors.forename: Fausto
authors.initials: F
authors.lastname: Rigo
authors.forename: Marco
authors.initials: M
authors.lastname: Marrani
authors.forename: Gennaro
authors.initials: G
authors.lastname: Provenza
authors.forename: Mario
authors.initials: M
authors.lastname: Leoncini
authors.forename: Joerge A
authors.initials: JA
authors.lastname: Salerno Uriarte
authors.forename: Francesco
authors.initials: F
authors.lastname: Bovenzi
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bossone
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D023921:Coronary Stenosis / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D012307:Risk Factors; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D013997:Time Factors