Premium
Long‐term excess mortality in takotsubo cardiomyopathy: predictors, causes and clinical consequences
Author(s) -
Stiermaier Thomas,
Moeller Christian,
Oehler Katrin,
Desch Steffen,
Graf Tobias,
Eitel Charlotte,
Vonthein Reinhard,
Schuler Gerhard,
Thiele Holger,
Eitel Ingo
Publication year - 2016
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.494
Subject(s) - medicine , hazard ratio , confidence interval , myocardial infarction , killip class , cardiology , heart failure , mortality rate , cardiomyopathy , proportional hazards model , cohort , ejection fraction
Aims 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 ). Methods and results 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. Conclusion 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.