Patient characteristics and incidence of in-hospital events in spontaneous coronary artery dissection and suspected concurrent Takotsubo syndrome: A report of the iSCAD registry

Background and objectives: Takotsubo syndrome (TTS) and spontaneous coronary artery dissection (SCAD) are both more common in middle-aged women and often share similar triggers, such as emotional or physical stress. This study aimed to examine the characteristics and in-hospital prognosis of patients with SCAD and possible concomitant TTS. Methods: Patients from the iSCAD Registry with completed questionnaires, case report forms, and available coronary angiography and ventriculography adjudicated by a core lab were included. In the absence of follow-up imaging confirming resolution of the wall motion abnormalities a definitive diagnosis of TTS cannot be established, therefore this pattern will be referred to throughout the manuscript as TTS-like angiographic pattern (TVP). Coexistent TVP was defined by classic apical ballooning or wall motion abnormalities discordant with the dissected coronary territory. In-hospital events included recurrent myocardial infarction (MI), cerebrovascular accident, heart failure (HF) requiring diuretics, and new arrhythmias. Patient characteristics and in-hospital events were compared between TVP and non-TVP groups. Results: Among 259 study participants, 44 (17.0%) were identified with coexistent TVP. There were no significant differences in age, cardiovascular risk factors, anxiety or depression history, recreational substance use, emotional or physical stressors, or extracoronary vascular abnormalities between the TVP and non-TVP groups. Patients with TVP were more likely to present with ST-segment elevation MI, left ventricular dysfunction, left anterior descending artery involvement, and abnormal myocardial perfusion compared to non-TVP patients. Furthermore, TVP patients had a higher incidence of experiencing in-hospital events (34.1% vs. 13.1%; p < 0.001), primarily driven by new arrhythmias (21.4% vs. 6.4%; p = 0.002) and HF (10.0% vs. 2.0%; p = 0.010). After multivariable adjustment, coexistent TVP remained associated with in-hospital events. Conclusions: In this SCAD cohort, patients with concurrent TVP had a greater risk of new arrhythmias or HF during hospitalization. Study registration: URL: http://www.clinicaltrials.gov. Identifier: NCT04496687.