Male patients with Takotsubo syndrome at higher risk of death

Takotsubo syndrome (TTS) in male patients exhibit a distinct high-risk phenotype that needs close in-hospital monitoring and long-term follow-up, according to a study.

This study sought to describe sex differences in TTS among patients enrolled in the international multicenter GEIST (GErman Italian Spanish Takotsubo) registry. The authors compared male and female patients within the overall cohort using an adjusted analysis with 1:1 propensity score matching for age, comorbidities, and kind of trigger.

Of the 2,492 TTS patients included, 286 (11 percent) were men. Male patients were younger (69 vs 71 years; p=0.005) and had higher prevalence of comorbidities (diabetes mellitus: 25 percent vs 19 percent; p=0.01; pulmonary diseases: 21 percent vs 15 percent; p=0.006; malignancies: 25 percent vs 13 percent; p<0.001) and physical triggers (55 percent vs 32 percent; p<0.01).

Propensity-score matching yielded 207 patients from each group. Male patients were found to have higher rates of cardiogenic shock (16 percent vs 6 percent) and in-hospital mortality (8 percent vs 3 percent; p<0.05 for both).

Long-term mortality rate was 4.3 percent per patient-year (men: 10 percent; women: 3.8 percent). Analysis revealed a higher mortality rate in men during the acute phase in both cohorts (overall: p<0.001; matched: p=0.001). Moreover, mortality rate after 60 days remained higher in men in the overall (p=0.001) but not in the matched cohort (p=0.541).

Within the overall population, male sex still independently contributed to both in-hospital (odds ratio, 2.26, 95 percent confidence interval [CI], 1.16‒4.40) and long-term mortality (HR, 1.83, 95 percent CI, 1.32‒2.52).