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

  • Nathalie Auger
    Correspondence
    Requests for reprints should be addressed to Nathalie Auger, MD, Institut national de santé publique du Québec, 190 Cremazie Blvd E, Montreal, Quebec H2P 1E2, Canada.
    Affiliations
    University of Montreal Hospital Research Centre, Quebec, Canada

    Institut national de santé publique du Québec, Montreal, Quebec, Canada

    Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada

    Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Quebec, Canada
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  • Gilles Paradis
    Affiliations
    Institut national de santé publique du Québec, Montreal, Quebec, Canada

    Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
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  • Jessica Healy-Profitós
    Affiliations
    University of Montreal Hospital Research Centre, Quebec, Canada

    Institut national de santé publique du Québec, Montreal, Quebec, Canada
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  • Siyi He
    Affiliations
    University of Montreal Hospital Research Centre, Quebec, Canada

    Institut national de santé publique du Québec, Montreal, Quebec, Canada
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  • Brian J. Potter
    Affiliations
    University of Montreal Hospital Research Centre, Quebec, Canada

    Division of Cardiology, Department of Medicine, University of Montreal Hospital Center, Quebec, Canada
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Published:October 24, 2019DOI:https://doi.org/10.1016/j.amjmed.2019.09.023

      Abstract

      Background

      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.

      Methods

      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.

      Results

      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.

      Conclusions

      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.

      Keywords

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