Coexistence and outcome of coronary artery disease in takotsubo syndrome

L. Christian Napp, Victoria L. Cammann, Milosz Jaguszewski, Konrad A. Szawan, Manfred Wischnewsky, Sebastiano Gili, Maike Knorr, Susanne Heiner, Rodolfo Citro, Eduardo Bossone, Fabrizio D'Ascenzo, Michael Neuhaus, Jennifer Franke, Ioana Sorici-Barb, Michel Noutsias, Christof Burgdorf, Wolfgang Koenig, Behrouz Kherad, Annahita Sarcon, Lawrence RajanGuido Michels, Roman Pfister, Alessandro Cuneo, Claudius Jacobshagen, Mahir Karakas, Alexander Pott, Philippe Meyer, Jose D. Arroja, Adrian Banning, Florim Cuculi, Richard Kobza, Thomas A. Fischer, Tuija Vasankari, K. E. Juhani Airaksinen, Christian Hauck, Carla Paolini, Claudio Bilato, Yoichi Imori, Ken Kato, Yoshio Kobayashi, Grzegorz Opolski, Monika Budnik, Rafal Dworakowski, Philip MacCarthy, Christoph Kaiser, Stefan Osswald, Leonarda Galiuto, Wolfgang Dichtl, Christina Chan, Paul Bridgman, Daniel Beug, Clément Delmas, Olivier Lairez, Ibrahim El-Battrawy, Ibrahim Akin, Ekaterina Gilyarova, Alexandra Shilova, Mikhail Gilyarov, John D. Horowitz, Karolina Polednikova, Petr Tousek, Petr Widimsky, David E. Winchester, Jan Galuszka, Christian Ukena, Gregor Poglajen, Pedro Carrilho-Ferreira, Carlo Di Mario, Abhiram Prasad, Charanjit S. Rihal, P. Christian Schulze, Matteo Bianco, Filippo Crea, Martin Borggrefe, Lars S. Maier, Fausto J. Pinto, Ruediger C. Braun-Dullaeus, Wolfgang Rottbauer, Hugo A. Katus, Gerd Hasenfuß, Carsten Tschöpe, Burkert M. Pieske, Holger Thiele, Heribert Schunkert, Michael Böhm, Stephan B. Felix, Thomas Münzel, Jeroen J. Bax, Johann Bauersachs, Eugene Braunwald, Thomas F. Lüscher, Frank Ruschitzka, Jelena R. Ghadri, Christian Templin

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Aims Takotsubo syndrome (TTS) is an acute heart failure syndrome, which shares many features with acute coronary syndrome (ACS). Although TTS was initially described with angiographically normal coronary arteries, smaller studies recently indicated a potential coexistence of coronary artery disease (CAD) in TTS patients. This study aimed to determine the coexistence, features, and prognostic role of CAD in a large cohort of patients with TTS. Methods Coronary anatomy and CAD were studied in patients diagnosed with TTS. Inclusion criteria were compliance with and results the International Takotsubo Diagnostic Criteria for TTS, and availability of original coronary angiographies with ventriculography performed during the acute phase. Exclusion criteria were missing views, poor quality of angiography loops, and angiography without ventriculography. A total of 1016 TTS patients were studied. Of those, 23.0% had obstructive CAD, 41.2% had non-obstructive CAD, and 35.7% had angiographically normal coronary arteries. A total of 47 patients (4.6%) underwent percutaneous coronary intervention, and 3 patients had acute and 8 had chronic coronary artery occlusion concomitant with TTS, respectively. The presence of CAD was associated with increased incidence of shock, ventilation, and death from any cause. After adjusting for confounders, the presence of obstructive CAD was associated with mortality at 30 days. Takotsubo syndrome patients with obstructive CAD were at comparable risk for shock and death and nearly at twice the risk for ventilation compared to an age- and sex-matched ACS cohort. Conclusions Coronary artery disease frequently coexists in TTS patients, presents with the whole spectrum of coronary pathology including acute coronary occlusion, and is associated with adverse outcome.

Original languageEnglish (US)
Pages (from-to)3255-3268
Number of pages14
JournalEuropean heart journal
Issue number34
StatePublished - Sep 7 2020


  • Acute coronary syndrome
  • Cardiac catheterization
  • Coronary artery disease
  • Myocardial infarction
  • Outcome
  • Takotsubo syndrome

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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