Takotsubo Syndrome: Does Gender Impact Prognosis?

Takotsubo Syndrome (STT) is characterized by acute cardiac failure which can be reversed in many occasions, but is associated with morbidity and mortality at short and long term.

Síndrome de Tokotsubo ¿El género tiene influencia en su pronóstico?

It is most frequent among women, especially after menopause. However, gender differences have not been looked into when analyzing the evolution of this cardiomyopathy.

This was an analysis of the GEIST Registry including 2492 patients with STT. 286 were men (11%).

Men were younger (69 vs. 71, P=0.005), presented more smoking, diabetes, pulmonary disease, and cancer. In addition, they presented more dyspnea and less precordial pain vs. women.

STT triggering episodes were more physical in men and more emotional in women.

There were no differences in ECG, but there was in ejection fraction, which was lower in men (38% vs. 40% P=0.001).

Men presented more cardiogenic shock (19% vs. 8% P<0.001), inhospital mortality (7% vs. 2% P<0.001) and longer hospital stay.

After propensity score matching 207 pair of patients were left in each group: men had more cardiogenic shock and higher mortality (16% vs 6%, P=0.002 and 8% vs 3%; P=0.003 respectively).

At long term followup, mortality was 4.3% patient/ years, and was higher in men (10% vs. 3.8% patient /year in the complete series, and 11.5% vs 6.1% patient/year in the matched cohort, respectively). At 60-day followup, mortality was higher in men, but this was not the case in the matched cohort.

Multivariable analysis showed that male sex was a predictor of inhospital mortality and mortality at followup.