P810Novel scoring system for takotsubo syndrome

• Published in: European heart journal Vol. 40; no. Supplement_1
• Main Authors: Di Vece, D, Kato, K, Bacchi, B, Candreva, A, Cammann, V L, Szawan, K A, Hermes-Laufer, J, Micek, J, Wischnewsky, M, Ghadri, J R, Templin, C
• Format: Journal Article
• Language: English
• Published: Oxford University Press 01.10.2019
• Subjects: Acute Coronary Syndromes: Tako-Tsubo Cardiomyopathy
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehz747.0409

Abstract Background Scoring systems for risk stratification in takotsubo syndrome (TTS) are lacking. Purpose The present study aimed to develop a score to predict the overall mortality in TTS. Methods TTS patient were enrolled from a multicenter registry. Parameters known to be associated with adverse outcomes in TTS were identified based on current literature. A multivariable analysis including these parameters was conducted and those which were found to be significantly associated with mortality were considered in the scoring system. For each patient, the prognostic score was derived by summing the respective points of each prognostic factor. Based on cut-off values, patients were categorized into four groups including low, intermediate, high, and very high risk. Results A total of 1160 patients (90.8% females; mean age 66.5±13.0 years) were included in the present study. Regarding triggering factors, an emotional trigger was identified in 32.6% of TTS patients while 32.1% had preceding physical activities, medical conditions, or procedures and 5.7% had preceding neurologic disorders. The remaining patients (29.7%) had no identifiable triggering factors. According to the results from multivariable analysis, points were assigned to each parameter that was independently associated with long-term mortality: 15 points for neurologic trigger, 10 points for the other physical trigger, 8 points for Age >70 years, 7 points for male sex, 7 points for left ventricular ejection fraction ≤45%, 6 points for diabetes mellitus, 5 points for heart rate >94 bpm on admission, 5 points for systolic blood pressure >140 mmHg on admission, and 2 points for no identifiable trigger. Based on the total points, patients were categorized into four prognostic groups: low-risk ≤15 points (43.5%), intermediate-risk 16–22 points (28.0%), high-risk 23–29 points (18.0%), and very high-risk >29 points (10.5%). Conclusion This novel score for risk stratification in TTS only requires easy-obtainable variables to clinicians even in the acute phase and could identify low to very high risk of overall mortality. Thus, it could potentially serve as a useful clinical tool to predict prognosis in patients with TTS.