RESUMO
Aim: Whether Takotsubo syndrome (TTS) should be classified within myocardial infarction with non-obstructive coronary arteries (MINOCAs) is still controversial. The aim of this work was to evaluate the main differences between TTS and non-TTS MINOCAs. Methods and Results: A cohort study based on two prospective registries: TTS from the RETAKO registry (N:1,015) and patients with non-TTS MINOCAs from contemporary records of acute myocardial infarction from five 5 national centers (N:1,080). Definitions and management recommended by the ESC were used. Survival analysis was based on the Cox regression analysis; propensity score matching (PS) was created to adjust prognostic variables. Takotsubo syndrome were more often women (85.9 vs. 51.9%; p < 0.001) and older (69.4 ± 12.5 vs. 64.5 ± 14.1 years; p < 0.001). Atrial fibrillation (AF) was more frequent in non-TTS MINOCAs (10.4 vs. 14.4%; p = 0.007). Psychiatric disorders were more prevalent in TTS (15.5 vs. 10.2%, p < 0.001). In-hospital mortality and complications were higher in TTS: 3.4 vs. 1.8%, (p = 0.015), and 25.8 vs. 11.5%, (p < 0.001). Global mortality before PS matching was 16.1% in non-TTS MINOCAs and 8.1% in TTS. Median follow-up was 32.4 months; after PS matching, TTS had fewer major adverse cardiovascular events (MACEs): hazard ratio (HR) 0.59; 95% CI 0.42-0.83. There were no differences in global mortality (HR 0.87; CI: 0.64-1.19), but TTS had lower cardiovascular mortality (HR 0.58; CI: 0.35-0.98). Conclusion: Compared to the rest of MINOCAs, TTS presents a different patient profile and a more aggressive acute phase. However, its long-term cardiovascular prognosis is better. These results support that TTS should be considered a separate entity with unique characteristics and prognosis.
RESUMO
Se comunica el caso de un varón de 21 años de edad, sin antecedentes de cardiopatía, en quién se estableció el diagnóstico de infarto agudo del miocardio de localización anterior y lateral alta como consecuencia de un traumatismo no penetrante de tórax, debido a la patala de un caballo recibido en la cara anterior del tórax. Su sintomatología fundamental era dolor retroesternal diez minutos después del trauma. El examen físico era sugestivo de taponamiento cardíaco (que no se comprobó). La radiología de tórax fué normal y el electrocardiograma mostró cambios sugestivos de infarto lateral alto con lesión subendocárdica anterior extensa. El estudio radio-isotópico con Talio 201, después del ejercicio, evidenció hipocaptación difusa, sugestiva de contusión miocárdica. La ventriculocoronariografía realizada el día posterior al traumatismo, reveló zona de acinesia posterobasal y coronarias de apariencia normal