Coincidental coronary artery disease impairs outcome in patients with takotsubo cardiomyopathy.
OBJECTIVE
Takotsubo cardiomyopathy (TC) is an important differential diagnosis of coronary artery disease (CAD), mimicking acute coronary syndrome in clinical symptoms, biomarker profiles and ST-elevation in ECG. Absence of occlusive coronary disease is an essential criterion distinguishing both diseases. The aim of the study was to explore the influence of co-existing incidental CAD on poorer clinical outcomes and all-cause mortality in TC.


METHODS
Our mono-centric study cohort constituted 114 consecutive patients diagnosed with TC between 2003 and 2015. The primary endpoint was the all-cause mortality. Additionally, we compared the incidence of thromboembolic events, life-threatening arrhythmias, cardiogenic shock and in-hospital death. There was no significant difference in gender distribution or mean age in both groups. Patients diagnosed with a co-existing CAD (n = 22), had a more pronounced cardiovascular risk profile. The all-cause mortality among patients with co-existing CAD after a 2-year follow-up was higher than those diagnosed with lone TC (22.7 vs. 5.4 %, P = 0.07). In a multivariate cox regression analysis CAD (HR 3.5, 95 %CI 1.0-11.6; P = 0.04), LVEF ≤ 35% (HR 3.8, 95% CI 0.0-0.6, P = 0.01) and cardiogenic shock (HR 3.8, 95% CI 1.2-11.3; P = 0.01) were independent predictors of the primary endpoint.


CONCLUSIONS
Our study reveals that co-existing CAD impairs the outcome in patients with TC. The diagnostic work-up for TC should therefore not necessarily hinge on ruling out CAD.
First Department of Medicine Cardiology, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany and DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Mannheim, Germany.
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Bill
First Department of Medicine Cardiology, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany and DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Mannheim, Germany.
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El-Battrawy
First Department of Medicine Cardiology, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany and DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Mannheim, Germany.
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Schramm
First Department of Medicine Cardiology, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany and DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Mannheim, Germany.
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Ansari
First Department of Medicine Cardiology, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany and DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Mannheim, Germany.
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Hoffmann
First Department of Medicine Cardiology, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany and DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Mannheim, Germany.
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Haghi
First Department of Medicine Cardiology, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany and DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Mannheim, Germany.
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Kuschyk
First Department of Medicine Cardiology, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany and DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Mannheim, Germany.
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Borggrefe
First Department of Medicine Cardiology, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany and DZHK (German Centre for Cardiovascular Research) Partner Site Mannheim, Mannheim, Germany.
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Akin
D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000401:mortality* / Q000503:physiopathology* / Q000628:therapy; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005858:Germany; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D054549:Takotsubo Cardiomyopathy / Q000401:mortality* / Q000503:physiopathology* / Q000628:therapy