Gender Differences in Takotsubo Syndrome

Quick Takes

  • Men represented 10% of the total cohort of patients presenting with takotsubo syndrome in this international multicenter registry.
  • Men with takotsubo syndrome had more comorbidities. Propensity-matched analysis showed increased in-hospital mortality among men compared to women but no difference in long-term mortality.
  • Findings suggest that minority men with takotsubo syndrome might have worst outcomes compared to women. Potential explanation for these findings remains speculative.

Study Questions:

What are gender-based differences among patients presenting with takotsubo syndrome (TTS)?


TTS patients enrolled in the international multicenter GEIST (GErman Italian Spanish Takotsubo) registry were analyzed. Comparisons between sexes were performed within the overall cohort and using an adjusted analysis with 1:1 propensity-score matching for age, comorbidities, and kind of trigger.


In total, 286 (11%) of 2,492 TTS patients were men. Male patients were younger (ages 69 ± 13 years vs. 71 ± 11 years; p = 0.005), with higher prevalence of comorbid conditions (diabetes mellitus 25% vs. 19%; p = 0.01; pulmonary diseases 21% vs. 15%; p = 0.006; malignancies 25% vs. 13%; p < 0.001, and physical trigger (55 vs. 32%; p < 0.01). Propensity-score matching yielded 207 patients from each group. After 1:1 propensity matching, male patients had higher rates of cardiogenic shock and in-hospital mortality (16% vs. 6% and 8% vs. 3%, respectively; both p < 0.05). Long-term mortality rate was 4.3% per patient-year (men 10%, women 3.8%). Survival analysis showed a higher mortality rate in men during the acute phase in both cohorts (overall: p < 0.001; matched: p = 0.001); mortality rate after 60 days was higher in men in the overall (p = 0.002) but not in the matched cohort (p = 0.541). Within the overall population, male sex remained independently associated with both in-hospital (odds ratio, 2.26; 95% confidence interval [CI], 1.16-4.40) and long-term (hazard ratio, 1.83; 95% CI, 1.32-2.52) mortality.


Male TTS is featured by a distinct high-risk phenotype requiring close in-hospital monitoring and long-term follow-up.


This analysis from a multicenter international registry reported on sex-based differences among patients with TTS. Men represented 10% of the total cohort and had more comorbidities. Among propensity-matched patients, men had significantly higher in-hospital mortality; however, long-term mortality was similar in men and women. Although these findings are limited by retrospective design, they do bring to light the possibility that minority men with TTS might have worst outcomes compared to women. Mechanisms to explain the sex-based differences remain poorly understood and deserve further study.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Cardiomyopathies, Comorbidity, Diabetes Mellitus, Heart Failure, Hospital Mortality, Lung Diseases, Male, Neoplasms, Phenotype, Sex Factors, Shock, Cardiogenic, Takotsubo Cardiomyopathy

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