Prevalence of incidental coronary artery disease in tako-tsubo cardiomyopathy

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Abstract
Earlier studies have often required the absence of obstructive coronary artery disease (CAD) as the criteria. However, it is probable that patients with tako-tsubo cardiomyopathy have an incidental CAD because most patients are elderly. We assessed the prevalence of incidental CAD. We reviewed coronary angiograms of 97 Japanese patients with tako-tsubo cardiomyopathy. A wrapped left anterior descending artery (LAD) was defined as a LAD that perfused at least one-quarter of the inferior wall of the left ventricle in the 30 degrees right anterior oblique projection. Ten patients (10%) had definitively incidental CAD defined as greater than 75% reduction in the luminal diameter of the major epicardial coronary artery. All patients had ST-segment elevation, and five patients had T-wave inversion on admission. Nine patients had single vessel disease, and one patient had double vessel disease. Six patients had CAD in the nonwrapped LAD, and they were judged to be definitively incidental. Three patients had CAD in the left circumflex artery, and two patients had CAD in the right coronary artery. This study showed that incidental CAD was found in 10% of Japanese patients with tako-tsubo cardiomyopathy. In patients with CAD in the LAD, it should be carefully judged whether the CAD causes left ventricular apical ballooning to avoid performing coronary revascularization unnecessarily.