Long-Term Prognosis of Patients With Takotsubo Syndrome.
Ghadri JR., Kato K., Cammann VL., Gili S., Jurisic S., Di Vece D., Candreva A., Ding KJ., Micek J., Szawan KA., Bacchi B., Bianchi R., Levinson RA., Wischnewsky M., Seifert B., Schlossbauer SA., Citro R., Bossone E., Münzel T., Knorr M., Heiner S., D'Ascenzo F., Franke J., Sarcon A., Napp LC., Jaguszewski M., Noutsias M., Katus HA., Burgdorf C., Schunkert H., Thiele H., Bauersachs J., Tschöpe C., Pieske BM., Rajan L., Michels G., Pfister R., Cuneo A., Jacobshagen C., Hasenfuß G., Karakas M., Koenig W., Rottbauer W., Said SM., Braun-Dullaeus RC., Banning A., Cuculi F., Kobza R., Fischer TA., Vasankari T., Airaksinen KEJ., Opolski G., Dworakowski R., MacCarthy P., Kaiser C., Osswald S., Galiuto L., Crea F., Dichtl W., Empen K., Felix SB., Delmas C., Lairez O., El-Battrawy I., Akin I., Borggrefe M., Horowitz J., Kozel M., Tousek P., Widimský P., Gilyarova E., Shilova A., Gilyarov M., Winchester DE., Ukena C., Bax JJ., Prasad A., Böhm M., Lüscher TF., Ruschitzka F., Templin C.
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).