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Coexistence and prognostic impact of coronary artery disease in Takotsubo Syndrome
Session:
Sessão de Posters 32 - MINOCA
Speaker:
Marta Catarina Bernardo
Congress:
CPC 2024
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.7 Acute Coronary Syndromes - Other
Session Type:
Cartazes
FP Number:
---
Authors:
Marta Catarina Bernardo; Catarina Ribeiro Carvalho; Isabel Moreira; Luís Sousa Azevedo; Pedro Rocha Carvalho; Pedro Magalhães; Sofia Silva Carvalho; Ilídio Moreira
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Introduction: </strong>Takotsubo Syndrome (TTS) is characterized by regional wall motion abnormalities in the absence of significant epicardial coronary artery disease (CAD). However, the coexistence of CAD in TTS patients is not uncommon, and its prognostic significance remains uncertain.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Purpose:</strong> Evaluate the characteristics, in-hospital evolution and long-term prognosis in patients (pts) admitted with TTS with CAD comparing to the others. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Methods:</strong> We performed a retrospective study of pts admitted in a single centre between 2008 e 2023 with the diagnosis of TTS. Pts were categorized into two groups: those with CAD (coronary artery stenosis < 50%) and those without CAD (CADn). Major adverse cardiovascular events (MACCE) included heart failure hospitalization, cardiovascular mortality, stroke, and TTS recurrence. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Results: </strong>We included 114 pts, 86% females, median age 72,50 (IQR 63,0-79,25) years. CAD group included 26 pts and CADn 88 pts. CAD group pts were significantly older (mean age of 75,81±10,32 versus 68,93 ±12,32, p= 0,011) and had a higher male prevalence (30,8% versus 9,1%, p=0,005). As cardiovascular risk factors, CAD pts had a higher prevalence of dyslipidemia (58,0% vs 80,8%, p= 0,034) and diabetes mellitus (46,2% vs 21,6%, p= 0,013). Psychiatric disease was more prevalent in CADn group (28,4% versus 7,7%, p= 0,029). No significant differences were found in clinical presentation, electrocardiogram, pro-BNP, troponin levels and left ventricular ejection fraction (LVEF) at admission (mean 39,40±9,70 in CAD group versus 41,68±11,02 in CADn group, p= 0,33) or pre-discharge (CAD group- 51,38 ±12,77 vs CADn group- 51,96±10,60, p= 0,84). </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif">During hospitalization, CAD group had a higher incidence of intra-hospital complications, defined as heart failure, stroke and death (35,0% vs 16,2%, p= 0,023) and a greater use of diuretic therapy (73,1% versus 45,3% (p= 0,013)). At discharge, there was more prescription of furosemide in CAD group (52,0% vs 28,2%, p= 0,027). No other differences in the in-hospital medication and at discharge between the two groups. During a mean follow-up of 32,04 ± 25,35 months, CAD group had a higher incidence of MACCE (34,78% vs 16,0%, log rank p= 0,023). In a multivariate analysis, after adjusting for possible confounders, CAD was an independent predictor of MACE with a HR 3,19 (95% CI: 1,14-8,94, p= 0,028).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Conclusions: </strong>T</span></span><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif">he presence of concomitant coronary artery disease is frequent, more prevalent in older pts, males and in those with cardiovascular risk factors. CAD is associated with worse in-hospital and long-term prognosis. This raises the hypothesis that coronary angiography not only has a diagnostic but a prognostic role in TTS patients.</span></span></p>
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