Abstract 15129: Non-Obstructive Coronary Artery Disease in Apical Ballooning Syndrome (Takotsubo/Stress Cardiomyopathy): Characterization and Outcomes
Introduction: Apical Ballooning Syndrome (ABS) is a transient cardiomyopathy characterized by the lack of obstructive coronary artery disease (CAD). However, evidence of non-obstructive CAD is present in many patients.
Objectives: We sought to compare the clinical characteristics and outcomes of ABS patients with and without non-obstructive CAD.
Methods: We retrospectively evaluated the records of 219 patients meeting criteria for ABS. 12 patients were excluded due to lack of available catheterization imaging. For the remaining 207, CAD was defined as ≥ 50% stenosis in any vessel. We further evaluated if a major (left main, left anterior descending, circumflex, and right coronary) epicardial vessel was involved.
Results: Approximately 26% of patients had evidence of CAD. Major epicardial coronary artery involvement was as follows: LM (1.0%), LAD (7.4%), LCX (4.0%) and RCA (8.7%). CAD patients were older (69.8 vs. 63.5; p=0.004) and more likely to be smokers (40.0% vs. 21.0%; p=0.008). CAD trended towards increased rate of ST-elevation on ECG (p=0.10). Peak troponin-I level was significantly greater in CAD (4.9 ng/mL vs. 2.8 ng/mL; p=0.042). Mean initial EF did not differ significantly between those with CAD and those without. CAD was not associated with increased rate of CCU admission, mechanical ventilation, hemodynamic support, or increased length of stay. There was a trend towards decreased survival for those with any CAD (p=0.061). For those with major epicardial CAD, survival time from admission was significantly decreased compared to any other CAD (p=0.04).
Conclusions: One-fourth of ABS patients have concomitant CAD. These patients have higher peak troponin levels but no significant adverse outcomes associated with their initial hospitalization. However, long-term survival analysis indicates that patients with CAD tend to have an overall increased mortality especially when involving major epicardial coronary arteries.
- © 2013 by American Heart Association, Inc.