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Spontaneous coronary artery dissection (SCAD) and takotsubo cardiomyopathy (TCM) - A potential association
Mohsin Sheraz Mughal1, Hasan M Mirza2, Amit Bansal3
1United Health Services Heart and Vascular Institute, New York, USA.
Insights
Spontaneous coronary artery dissection (SCAD) and takotsubo cardiomyopathy (TCM) are strongly associated. Patients with SCAD are over 7 times more likely to have TCM, and vice versa, suggesting a common cause.
Area of Science:
- Cardiology
- Cardiovascular Research
- Clinical Medicine
Background:
- Spontaneous coronary artery dissection (SCAD) and takotsubo cardiomyopathy (TCM) are increasingly recognized cardiovascular conditions.
- While case reports suggest co-occurrence, the association between SCAD and TCM remains poorly understood.
Purpose of the Study:
- To investigate the potential association between SCAD and TCM.
- To determine the odds of concomitant diagnosis of SCAD and TCM.
Main Methods:
- Retrospective study utilizing the Nationwide Inpatient Sample database.
- Calculated odds ratios for TCM in SCAD patients and SCAD in TCM patients.
- Adjusted for demographic and clinical factors including age, gender, race, hypertension, hyperlipidemia, and diabetes mellitus.
Main Results:
- Patients hospitalized with SCAD were 7.12 times more likely to also have TCM (p < 0.0001).
- Patients hospitalized with TCM were 6.91 times more likely to have SCAD (p < 0.0001), after adjustments.
- These findings indicate a significant association between SCAD and TCM.
Conclusions:
- Patients diagnosed with SCAD or TCM are approximately seven times more likely to have both conditions concurrently.
- The data support a growing body of evidence for an association between SCAD and TCM.
- Further research into a common pathophysiologic mechanism underlying both SCAD and TCM is warranted.
Background:
Spontaneous coronary artery dissection and takotsubo cardiomyopathy are increasingly recognized in the last two decades. Case reports have shown both entities can present concomitantly - however, little is known about their association.
Methods:
In this retrospective study we aimed to explore a potential association between SCAD and TCM using the Nationwide Inpatient Sample. The odds of having TCM among patients with SCAD compared with those who did not have SCAD were calculated as an odds ratio. Conversely, the odds of having SCAD among patients with TCM compared with those who did not have TCM were also calculated. The primary outcome was the odds of TCM among patients with a primary diagnosis of SCAD and vice versa. The secondary endpoint was the odds of in-hospital mortality among patients with SCAD, and/or TCM.
Results:
Hospitalized patients who had SCAD were 7.12 (95 % CI: 6.28-8.08) times more likely to also have TCM than those who did not have SCAD (p < 0.0001).), while patients with TCM were 6.91 (95 % CI: 6.07-7.85) times more likely to have SCAD compared to those who didn't have TCM adjusted for age, gender, race, hypertension, hyperlipidemia, and diabetes mellitus (p < 0.0001).
Conclusion:
This data indicate that patients with either SCAD or TCM are seven times more likely to be diagnosed concomitantly with both, compared to the patients without either diagnosis [after adjusting for age, gender, race, hypertension, hyperlipidemia, and diabetes mellitus]. Our data are consistent with the growing body of evidence supporting an association between SCAD and TCM and raise the question of a common pathophysiologic mechanism.
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