Risk Stratification Using the CHA2DS2-VASc Score in Takotsubo Syndrome: Data From the Takotsubo Italian Network

J Am Heart Assoc. 2017 Sep 14;6(9):e006065. doi: 10.1161/JAHA.117.006065.


Background: The CHA2DS2-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 CHA2DS2-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 CHA2DS2-VASc score: Group A (≤1), B (2-3), and C (≥4). The median CHA2DS2-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 CHA2DS2-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 CHA2DS2-VASc score allows prediction of cardiovascular events and mortality at long-term follow-up.

Keywords: CHA2DS2‐VASc score; Takotsubo; Takotsubo cardiomyopathy; Takotsubo syndrome; anticoagulant; cardiovascular events; stroke.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Aged
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Italy / epidemiology
  • Male
  • Middle Aged
  • Odds Ratio
  • Prognosis
  • Prospective Studies
  • Registries*
  • Risk Assessment / methods*
  • Risk Factors
  • Severity of Illness Index
  • Takotsubo Cardiomyopathy / diagnosis
  • Takotsubo Cardiomyopathy / epidemiology*