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Eur J Heart Fail. 2016 Jun;18(6):650-6. doi: 10.1002/ejhf.494. Epub 2016 Mar 14.

Long-term excess mortality in takotsubo cardiomyopathy: predictors, causes and clinical consequences.

Author information

1
University of Leipzig - Heart Centre, Department of Internal Medicine - Cardiology, Leipzig, Germany.
2
University Heart Centre of Luebeck, Medical Clinic II, Department of Cardiology, Angiology, Intensive Care Medicine, Luebeck, Germany.
3
Centre for Clinical Trials and Institute of Medical Biometry and Statistics, University of Luebeck, Luebeck, Germany.

Abstract

AIMS:

Despite increasing research efforts, the prognostic consequences of takotsubo cardiomyopathy (TTC) remain largely unknown. The aim of this study was therefore to compare the long-term mortality rate of TTC patients with high-risk patients presenting with ST-segment elevation myocardial infarction (STEMI).

METHODS AND RESULTS:

A total of 286 patients with TTC were matched for age and gender with 286 STEMI patients. Outcome was obtained with a standardized telephone follow-up. The primary analysis determined long-term mortality. A secondary analysis was performed evaluating 28-day and 1-year mortality. Follow-up was available for 96% of patients after a mean of 3.8 ± 2.5 years. In TTC patients, long-term mortality was significantly higher compared with the matched STEMI cohort [24.7% vs. 15.1%, hazard ratio (HR) 1.58, 95% confidence interval (CI) 1.07-2.33; P = 0.02]. There was no significant difference in the rates of 28-day (5.5% vs. 5.7%, HR 0.96, 95% CI 0.47-1.94; P = 0.91) and 1-year mortality (12.5% vs. 9%, HR 1.42, 95% CI 0.85-2.38; P = 0.18). In multivariable regression analysis, male sex, a high Killip class on admission, and diabetes mellitus were identified as independent predictors of mortality in TTC patients. A risk score consisting of these factors showed a higher mortality with an increasing number of risk factors.

CONCLUSION:

Mortality rates in TTC patients are higher than previously expected and long-term mortality exceeded that of patients with STEMI. A simple risk score may provide an approach to identify high-risk patients and predict clinical prognosis.

KEYWORDS:

Apical ballooning syndrome; Long-term prognosis; Mortality; Stress cardiomyopathy; Takotsubo cardiomyopathy

PMID:
26990821
DOI:
10.1002/ejhf.494
[Indexed for MEDLINE]
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