title: Long-term excess mortality in takotsubo cardiomyopathy: predictors, causes and clinical consequences.
abstract: 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).
  
  
  
  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.
  
  
  
  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.
authors.affiliation: University of Leipzig - Heart Centre, Department of Internal Medicine - Cardiology, Leipzig, Germany.|University Heart Centre of Luebeck, Medical Clinic II, Department of Cardiology, Angiology, Intensive Care Medicine, Luebeck, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Stiermaier
authors.affiliation: University Heart Centre of Luebeck, Medical Clinic II, Department of Cardiology, Angiology, Intensive Care Medicine, Luebeck, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Moeller
authors.affiliation: University of Leipzig - Heart Centre, Department of Internal Medicine - Cardiology, Leipzig, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Oehler
authors.affiliation: University of Leipzig - Heart Centre, Department of Internal Medicine - Cardiology, Leipzig, Germany.|University Heart Centre of Luebeck, Medical Clinic II, Department of Cardiology, Angiology, Intensive Care Medicine, Luebeck, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Desch
authors.affiliation: University Heart Centre of Luebeck, Medical Clinic II, Department of Cardiology, Angiology, Intensive Care Medicine, Luebeck, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Graf
authors.affiliation: University of Leipzig - Heart Centre, Department of Internal Medicine - Cardiology, Leipzig, Germany.|University Heart Centre of Luebeck, Medical Clinic II, Department of Cardiology, Angiology, Intensive Care Medicine, Luebeck, Germany.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Eitel
authors.affiliation: Centre for Clinical Trials and Institute of Medical Biometry and Statistics, University of Luebeck, Luebeck, Germany.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Vonthein
authors.affiliation: University of Leipzig - Heart Centre, Department of Internal Medicine - Cardiology, Leipzig, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.affiliation: University of Leipzig - Heart Centre, Department of Internal Medicine - Cardiology, Leipzig, Germany.|University Heart Centre of Luebeck, Medical Clinic II, Department of Cardiology, Angiology, Intensive Care Medicine, Luebeck, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Thiele
authors.affiliation: University of Leipzig - Heart Centre, Department of Internal Medicine - Cardiology, Leipzig, Germany.|University Heart Centre of Luebeck, Medical Clinic II, Department of Cardiology, Angiology, Intensive Care Medicine, Luebeck, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Eitel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality*; D012737:Sex Factors; D054549:Takotsubo Cardiomyopathy / Q000401:mortality*
keywords: Apical ballooning syndrome; Long-term prognosis; Mortality; Stress cardiomyopathy; Takotsubo cardiomyopathy