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Age-Related Variations in Takotsubo Syndrome
Study Questions:
What are the age-related differences in takotsubo syndrome (TTS)?
Methods:
The investigators included patients diagnosed with TTS and enrolled in the International Takotsubo Registry between January 2011 and February 2017 in this analysis and stratified patients by age (younger: ≤50 years, middle-age: 51-74 years, elderly: ≥75 years). Baseline characteristics, hospital course, as well as short- and long-term mortality were compared among groups. Kaplan-Meier estimates were used to analyze all-cause mortality, and the log-rank test was executed for group comparisons. Furthermore, a landmark analysis with a landmark set at 60 days was conducted to investigate long-term mortality beyond the acute phase.
Results:
Of 2,098 TTS patients, 242 (11.5%) patients were ≤50 years of age, 1,194 (56.9%) were 51-74 years of age, and 662 (31.6%) were ≥75 years of age. Younger patients were more often men (12.4% vs. 10.9% vs. 6.3%; p = 0.002) and had an increased prevalence of acute neurological (16.3% vs. 8.4% vs. 8.8%; p = 0.001) or psychiatric disorders (14.1% vs. 10.3% vs. 5.6%; p < 0.001) compared with middle-aged and elderly TTS patients. Furthermore, younger patients more often had cardiogenic shock (15.3% vs. 9.1% vs. 8.1%; p = 0.004) and had a numerically higher in-hospital mortality (6.6% vs. 3.6% vs. 5.1%; p = 0.07). At multivariable analysis, younger (odds ratio [OR], 1.60; 95% confidence interval, 0.86-3.01; p = 0.14) and older age (OR, 1.09; 95% CI, 0.66-1.80; p = 0.75) were not independently associated with in-hospital mortality using the middle-aged group as a reference. There were no differences in 60-day mortality rates among groups.
Conclusions:
The authors concluded that TTS in younger patients is associated with severe complications requiring intensive care.
Perspective:
This study reports that patients ≤50 years of age accounted for about 10% of TTS patients, presented with atypical TTS forms more often and manifested with cardiogenic shock, and had an increased need for acute cardiac care treatment more often. Since younger patients appear to have a substantially worse in-hospital course, this group presents as a particularly vulnerable patient subset in need of close monitoring and intensive care. Furthermore, studies are indicated to identify characteristics other than age that differentiate various subtypes of TTS, which may impact management and prognosis.
Clinical Topics: Cardiovascular Care Team, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure
Keywords: Cardiomyopathies, Critical Care, Geriatrics, Heart Failure, Hospital Mortality, Mental Disorders, Middle Aged, Secondary Prevention, Shock, Cardiogenic, Takotsubo Cardiomyopathy
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