title: Diagnosis of takotsubo cardiomyopathy is increasing over time in patients presenting as ST-elevation myocardial infarction.
abstract: BACKGROUND
  Takotsubo cardiomyopathy often presents with the clinical signs of ST-elevation myocardial infarction (STEMI). The increase in scientific publications addressing this relatively rare condition may result in higher awareness and diagnosis of takotsubo cardiomyopathy.
  
  
  OBJECTIVE
  To assess the observed prevalence per year of takotsubo cardiomyopathy in a large registry of patients with STEMI, during a 12-year inclusion period.
  
  
  METHODS
  All patients presenting with STEMI at a large regional cardiology clinic were entered into a database (n = 8,413, mean age 63 ± 13 years). Takotsubo cardiomyopathy was diagnosed in 42 patients (0.5 %). Years of evaluation were defined as 'early years' (January 2002 to December 2007; n = 4350) and 'later years' (January 2008 to December 2013). Multivariable analyses were performed to adjust for differences in demographical and clinical variables.
  
  
  RESULTS
  In later years, the age of STEMI patients was slightly higher (64 ± 13 vs. 63 ± 13 years, p < 0.001), with more patients with clinical symptoms of shock (10 vs. 7 %, p < 0.001) or a history of percutaneous coronary intervention or hypertension (10 vs. 8 %, p = 0.001 and 37 vs. 34 %, p < 0.001). Smoking and a positive family history were less often observed during later years (39 vs. 46 %, p < 0.001 and 37 vs. 42 % p < 0.001). Patients with takotsubo cardiomyopathy were more often female (81 vs. 27 %, p = 0.001). Takotsubo cardiomyopathy was more often diagnosed in the later period (0.7 vs. 0.3 %, OR 2.4, 95 % CI 1.2-4.6, p = 0.009). The higher prevalence of takotsubo cardiomyopathy in recent years remained significant after adjustment for differences in patient characteristics (OR 2.1, 95 % CI 1.1-4.3).
  
  
  CONCLUSIONS
  Takotsubo cardiomyopathy is currently more often diagnosed in patients with STEMI compared with in earlier years. This is probably due to the increased scientific and clinical awareness among doctors, but the prevalence is still low.
authors.affiliation: Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands. a.m.otten@isala.nl.
authors.forename: A M
authors.initials: AM
authors.lastname: Otten
authors.affiliation: Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands.
authors.forename: J P
authors.initials: JP
authors.lastname: Ottervanger
authors.affiliation: Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands.
authors.forename: T
authors.initials: T
authors.lastname: Symersky
authors.affiliation: Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Suryapranata
authors.affiliation: Department of Cardiology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: de Boer
authors.affiliation: Department of Cardiology, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.
authors.forename: A H E M
authors.initials: AH
authors.lastname: Maas
keywords: Gender; STEMI; Takotsubo cardiomyopathy