The incidence and clinical correlates of acute in-hospital mortality of takotsubo
cardiomyopathy (TTC) are not clear. We performed a systematic review and meta-analysis
to consolidate the current evidence on acute mortality in TTC. We then assessed the
impact of “secondary” TTC, male gender, advancing age, and catecholamine use on mortality.
A comprehensive search of 4 major databases (EMBASE, Ovid MEDLINE, PubMed, and Google
Scholar) was performed from their inception to the first week of July 2013. We included
original research studies, recruiting ≥10 participants, published in English language,
and those that reported data on mortality and cause of death in patients with TTC.
Of 382 citations, 37 studies (2,120 patients with TTC) from 11 different countries
were included in the analyses. The mean age of the cohort was 68 years (95% confidence
interval [CI] 67 to 69) with female predominance (87%). The in-hospital mortality
rate among patients with TTC was 4.5% (95% CI 3.1 to 6.2, I2 = 60.8%). Among all deaths, 38% were directly related to TTC complications and rest
to underlying noncardiac conditions. Male gender was associated with higher TTC mortality
rate (odds ratio 2.6, 95% CI 1.5 to 4.6, p = 0.0008, I2 = 0%) so was “secondary” TTC (risk difference −0.11, 95% CI −0.18 to −0.04, p = 0.003,
I2 = 84%). The mean age of patients dying tended to be greater than that in the whole
cohort (72 ± 7 vs 65 ± 7 years). In conclusion, TTC is not as benign as once thought.
To reduce the mortality rate, greater efforts need to be directed to the diagnosis,
treatment, and ultimately prevention of “secondary” TTC.
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Article info
Publication history
Published online: February 03, 2014
Accepted:
January 3,
2014
Received in revised form:
January 3,
2014
Received:
November 28,
2013
Footnotes
This work was supported in part by research grants from the National Health and Medical Research Council of Australia, Canberra, Australia and the QEH Research Foundation, Adelaide, Australia.
See page 1426 for disclosure information.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
