Clinical characteristics and outcomes in Takotsubo syndrome vs. spontaneous coronary artery dissection: a systematic review and meta-analysis

Abstract

Background: Although a large body of literature describes Takotsubo syndrome (TTS) and spontaneous coronary artery dissection (SCAD) as having overlapping clinical features and benign outcome measures, they differ significantly in their pathophysiological mechanisms, demo-graphic profile, and natural history. Herein, we sought to investigate differences in clinical profile and outcomes between patients of these two conditions. Methods: Following PRISMA guidelines, we compared TTS and SCAD in adult patients regarding epidemiological, clinical, and prognostic features. A systematic search of PubMed, Embase, and Cochrane Library identified eligible studies, with data extracted and quality assessed using the Newcastle-Ottawa scale. Random effects models were applied for statistical analysis, with heterogeneity evaluated by I2 and sensitivity analysis conducted to ensure robustness. Results: Takotsubo syndrome patients presented more often with dyspnea (46.8% vs. 0.9%; p < 0.001), while SCAD patients displayed typical angina (p < 0.001). In-hospital outcomes were worse for TTS patients, with higher mortality (4.4% vs. 0.8%; RR = 7.41, p = 0.001) and major adverse cardiac events (43.3% vs. 5.2%; RR = 8.35, p < 0.001). At one year, TTS patients had higher all-cause mortality (12.5% vs. 0.8%; p < 0.001) and stroke (2.1% vs. 0.6%; RR = 5.08, p = 0.02). Conclusions: Poorer outcomes are associated with TTS compared to SCAD. SCAD patients demonstrate better prognoses but remain at risk for recurrent ischemic events.