Outcomes of Takotsubo Syndrome at 15 Years: A Matched Cohort Study

The association of takotsubo syndrome with future risk of cardiovascular and noncardiovascular morbidity and mortality is unclear. We assessed the long-term risk of morbidity and mortality in patients with takotsubo syndrome.

We performed a matched cohort study of 174 patients with takotsubo syndrome between 1989 and 2006 in Quebec, Canada, with 15 years of follow-up on future hospitalization outcomes. We matched takotsubo patients to 2 comparison groups, including 1736 patients with acute myocardial infarction and 1740 population controls. We estimated hazard ratios (HR) and 95% confidence intervals (CI) for the association of takotsubo syndrome with subsequent in-hospital mortality, cardiovascular morbidity, and other hospitalization outcomes.

During 15 years of follow-up, patients with takotsubo syndrome had a risk of in-hospital mortality similar to patients with myocardial infarction (HR 1.06; 95% CI, 0.81-1.38), but a lower risk of cardiovascular rehospitalization (HR 0.79; 95% CI, 0.66-0.95). Compared with population controls, however, takotsubo was associated with 1.59 times the risk of in-hospital mortality (95% CI, 1.21-2.09), 2.71 times the risk of cardiovascular rehospitalization (95% CI, 2.24-3.28), and 1.86 times the risk of hospitalization for stress and anxiety disorders (95% CI, 1.21-2.85). Associations were significantly stronger the first few years after the initial admission for takotsubo, and weakened over time.

Takotsubo syndrome is associated with a risk of mortality similar to that of myocardial infarction after 15 years, but a lower risk of cardiovascular rehospitalization. Patients with takotsubo syndrome nonetheless have more in-hospital mortality and cardiovascular morbidity than population controls.