Gender-Based Comparison of Takotsubo Syndrome versus Patients with Myocardial Infarction.

Disclosures: There is no potential conflict of interest to disclose for any of the co-authors.

Objectives: Takotsubo Syndrome (TTS) is an acute reversible left ventricular (LV) dysfunction. Recently published studies have highlighted a similar mortality rate as acute coronary syndrome (ACS). We compared the impact of gender differences on the outcome of TTS patients as compared to ACS patient.

Material and methods: We included a collective of 138 patients TTS between 2003 and 2016 at our institution. Patients were divided according to their gender into two groups (Males n = 21, 15% and females, n = 117, 85%). They were compared with a cohort of 300 patients with a diagnosis of ACS.

Results: On the acute phase, in male patients with TTS, a treatment with inotropic was more often required (33.3% vs. 11.5%, p < 0.01), were more susceptible to cardiogenic shock (28.6% vs. 12.5%, p < 0.04). Concerning the long term prognosis after the acute event, male patients had higher all-cause mortality over long-term follow-up. A Kaplan-Meier analysis indicated that the mortality of male patients with TTS was significantly higher compared to male patients with ACS (log-rank<0.01), while there was no significant difference between female patients with TTS and ACS (log-rank=0.60, p = 0.45). In a multivariate cox regression analysis, male gender (HR 2.7, 95% CI: 1.1-6.5, p = 0.02) GFR<60 ml/min. (HR 2.8, 95% CI: 1.2-6.0, p = 0.01) and history of cancer (HR 3.6, 95% CI 1.4-9.3, p < 0.01) were independent predictors of 5 year mortality.

Conclusions: Considerable evidence suggests that TTS compared to ACS implicates more significant clinical short-term events on male patients and it may be associated with poorer long-term prognosis.