Risk Stratification Using the CHA 2 DS 2 -VASc Score in Takotsubo Syndrome: Data From the Takotsubo Italian Network.

Background: The CHA ₂ DS ₂ -VASc score predicts stroke in patients with atrial fibrillation and has been reported to have a prognostic role even in acute coronary syndrome patients. The Takotsubo syndrome is a condition that mimics acute coronary syndrome and may present several complications including stroke. We sought to assess the ability of CHA ₂ DS ₂ -VASc score to predict adverse events in Takotsubo syndrome patients.
Methods and Results: Overall, 371 Takotsubo syndrome patients were enrolled in a prospective registry. Patients were divided into 3 groups according to the CHA ₂ DS ₂ -VASc score: Group A (≤1), B (2-3), and C (≥4). The median CHA ₂ DS ₂ -VASc score was 3 (interquartile range: 2-4). Overall, 9%, 42%, and 49% were included in Group A, B, and C, respectively. Follow-up length was 26±20 months. The mortality rate was 6%, 7%, and 17% in Group A, B, and C, respectively ( P =0.011). The stroke rate was 3% and not different among the 3 groups. Estimated major adverse cardiac and cerebrovascular events (the composite of death, myocardial infarction, and stroke) rates in the 3 groups were 6%, 9%, and 17% in Group A, B, and C, respectively ( P =0.033). The CHA ₂ DS ₂ -VASc score resulted as a predictor of major adverse cardiac and cerebrovascular events (odds ratio 2.1, 95% confidence interval, 1.2-3.6; P =0.01) and all-cause mortality (odds ratio 1.5, 95% confidence interval, 1.2-1.9; P =0.001).
Conclusions: In Takotsubo syndrome, the CHA ₂ DS ₂ -VASc score allows prediction of cardiovascular events and mortality at long-term follow-up.
(© 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.)