Abstract 3931: Clinical Management and Therapeutic Strategies in Patients With Tako-Tsubo Cardiomyopathy
Background: Tako-tsubo cardiomyopathy (TTC) has increasingly been recognized all over the world. So far no trial data are available to guide the treatment of TTC. This study evaluated clinical management and therapeutic strategies in patients of the German TTC registry.
Methods: 314 pts from 37 hospitals were included according established TTC criteria. Clinical course and acute as well as long term treatment was assessed.
Results: Of 314 TTC pts (age 68±12), 287 were female (91%), 27 male (9%). Main symptoms were angina (72%), dyspnea (16%), and syncope (3%), 2% were resuscitated or in cardiogenic shock. A triggering event was present in 77% (emotional stress 37%, physical stress 31%, both 9%). Pts were admitted to the hospital by an emergency team with physician (46%), general practitioner (24%), ambulance without physician (13%) or by directly contacting the emergency room (12%). In 6% TTC developed during hospitalization for another disease. The initial clinical diagnosis was STEMI (48%), NSTEMI (40%) or pulmonary embolism (1%); 12% were admitted with other diagnoses. Time from symptom onset to hospital admission was 7.7±6.9 hours. Concordant with the diagnosis of an acute coronary syndrome (ACS), 71% pts were transferred to the intensive care unit. The acute medication could be evaluated in 209 pts and included heparin (91%), aspirin (89%, combined with clopidogrel in 42%), beta-blocker (65%), nitroglycerine (47%), ACE-inhibitor (38%) and diuretics (37%). Catecholamines or an intraaortic balloon pump were necessary in 5% and 1%, respectively. Complications were atrial fibrillation (16%), ventricular tachycardia (9%), lung edema (14%), intraventricular pressure gradient (4%), LV thrombi (3%), myocardial rupture (0,5%), cardiogenic shock (7%) and death (2%). Medication at discharge was known in 236 pts and included aspirin or clopidogrel (67%), beta-blocker (75%), ACE-Inhibitor (77%) and calcium-antagonist (19%). 7 pts had a recurrence during follow up.
Conclusion: In this large registry, 88% of TTC pts get an initial diagnosis of an ACS and are treated by monitoring in the intensive care unit, cardiac catheterisation and medications corresponding to the guidelines for STEMI and NSTEMI. Mortality and recurrence rate appear to be low.