Original Investigation
Long-Term Prognosis of Patients With Takotsubo Syndrome

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Abstract

Background

Prognosis of Takotsubo syndrome (TTS) remains controversial due to scarcity of available data. Additionally, the effect of the triggering factors remains elusive.

Objectives

This study compared prognosis between TTS and acute coronary syndrome (ACS) patients and investigated short- and long-term outcomes in TTS based on different triggers.

Methods

Patients with TTS were enrolled from the International Takotsubo Registry. Long-term mortality of patients with TTS was compared to an age- and sex-matched cohort of patients with ACS. In addition, short- and long-term outcomes were compared between different groups according to triggering conditions.

Results

Overall, TTS patients had a comparable long-term mortality risk with ACS patients. Of 1,613 TTS patients, an emotional trigger was detected in 485 patients (30%). Of 630 patients (39%) related to physical triggers, 98 patients (6%) had acute neurologic disorders, while in the other 532 patients (33%), physical activities, medical conditions, or procedures were the triggering conditions. The remaining 498 patients (31%) had no identifiable trigger. TTS patients related to physical stress showed higher mortality rates than ACS patients during long-term follow-up, whereas patients related to emotional stress had better outcomes compared with ACS patients.

Conclusions

Overall, TTS patients had long-term outcomes comparable to age- and sex-matched ACS patients. Also, we demonstrated that TTS can either be benign or a life-threating condition depending on the inciting stress factor. We propose a new classification based on triggers, which can serve as a clinical tool to predict short- and long-term outcomes of TTS. (International Takotsubo Registry [InterTAK Registry]; NCT01947621)

Key Words

acute coronary syndrome
broken heart syndrome
classification
outcome
stress factor
Takotsubo syndrome

Abbreviations and Acronyms

ACS
acute coronary syndrome
CI
confidence interval
HR
hazard ratio
TTS
Takotsubo syndrome

Cited by (0)

Dr. Ghadri has received a research grant “Filling the gap” from the University of Zurich. Dr. Napp has received lecture honoraria from Abiomed, Cytosorbents, KelCon, Maquet, and Zoll; has received consultant fees from Abiomed, Bayer, and Cytosorbents; and has received traveling or congress support from Abbott, Abiomed, Bayer, Biotronik, Boston Scientific, Lilly, Medtronic, Merit Medical, Pfizer, Servier, and Volcano. Dr. Noutsias has received honoraria for presentations and/or participated in advisory boards from Abiomed, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Fresenius, Miltenyi Biotech, Novartis, Pfizer, and Zoll. Dr. Hasenfuß has served as a consultant for Corvia, Servier, Impulse Dynamics, Novartis, and Vifor Pharma; has received lecture fees from Corvia, Servier, Novartis, AstraZeneca, and Vifor Pharma; has served as co-PI for Impulse Dynamics; and has served on the Editorial Board of Springer. Dr. Koenig has received modest consultation fees for advisory board meetings from Novartis, Pfizer, DalCor, Sanofi, Kowa, and Amgen; and has received modest personal fees for lectures from Novartis, Pfizer, Sanofi, AstraZeneca, and Amgen. Dr. Bax’s institution, The Department of Cardiology at Leiden University Medical Center, has received unrestricted research grants from Biotronik, Medtronic, Boston Scientific, and Edwards Lifesciences. Dr. Ruschitzka has attended Advisory Board meetings for AstraZeneca, Sanofi, Amgen, Bristol-Myers Squibb, Pfizer, and Roche; has attended Steering Committee meetings for Fresenius and Vifor; has received lecture fees from St. Jude Medical, Servier, Zoll, Novartis, Bayer, and Abbott; and has received research grants from St. Jude Medical and Novartis. Dr. Templin has been supported by the H.H. Sheikh Khalifa bin Hamad Al-Tani Research Programme. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Listen to this manuscript's audio summary by JACC Editor-in-Chief Dr. Valentin Fuster.

Drs. Ghadri and Kato contributed equally to this work.