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Takotsubo cardiomyopathy (TTC) is characterized by transient left ventricular dysfunction in the absence of causative obstructive coronary artery disease. The prognosis of TTC is generally favorable. Symptoms, ECG, Biomarkers profile and Echocardiography findings can be identical to acute coronary syndrome (ACS). To assess the importance of coronary angiography (CA) in the initial management of patients with suspected TTC, we compared the in-hospital mortality in suspected TTC patients managed without CA (TTC-NCA) to those managed with CA (TTC-CA).
The Nationwide Inpatient Sample (NIS), part of the Healthcare Cost and Utilization Project, is the largest publicly available inpatient care database designed to provide information on characteristics and outcomes of patients discharged from United States community hospitals. We identified 2399 adult patients in the NIS with a primary diagnosis of TTC in the calendar years 2008 to 2010. Of those, 261 were patients with TTC-NCA.
Patients with TTC-NCA were slightly older (66.3yrs. vs. 65.7yrs. p=0.009) and had a higher prevalence of chronic kidney disease (11.5% vs. 5% p<0.001) and atrial fibrillation (15.3% vs. 10.2%, p=0.012), but had similar female preponderance (91.2% vs. 92.6% ns), racial composition, and prevalence of diabetes and hypertension compared to TTC-CA patients. They had a similar incidence of shock (3.4% vs. 3.5% ns) and rate of major operations during their hospital stay (4.6% vs. 5.8%, ns). The rate of blood transfusions was higher in the TTC-NCA group (4.6% vs. 2.4%, p=0.035) as was the hospital length of stay (4.4 vs. 3.6 days, p=0.009). The in-hospital mortality rate was significantly higher in the TTC-NCA patients compared to the TTC-CA patients (2.7% vs. 0.9%, p=0.012). After adjusting for pertinent clinical and procedural variables using logistic regression analysis, not undergoing CA was an independent predictor of higher in-hospital mortality (p = 0.033, OR 2.70 [1.08–6.75]).
Patients diagnosed with TTC without the use of CA, have a higher in-hospital mortality compared to those diagnosed with CA. This is possibly due to false inclusion of ACS patients in the former group.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Stress, Coronary Spasm and AMI: Lessons from Japan, New Orleans, Greece
Abstract Category: 1. Acute Coronary Syndromes: Clinical
Presentation Number: 1130-211
- 2013 American College of Cardiology Foundation