Comparison of clinical features and outcomes of Chinese patients with Takotsubo syndrome and acute myocardial infarction—results from the first Chinese Takotsubo syndrome registry

Background: Takotsubo syndrome (TTS) differs significantly from acute myocardial infarction (AMI) in clinical features and pathological mechanisms, but evidence in Asian populations remains limited. The aim of this study is to compare clinical features and outcomes between patients with TTS and AMI in the first Chinese registry of TTS (ChiTTS Registry, ChiCTR1900026725). Methods: In this multicenter 6-year retrospective cohort study (February 2016–June 2022), a total of 116 consecutive TTS patients diagnosed according to the international Takotsubo diagnostic criteria and 232 age- and sex-matched AMI patients (1:2 ratio) meeting the 2023 European Society of Cardiology guidelines criteria were enrolled from 10 tertiary medical centers across China. Clinical characteristics, in-hospital outcomes, and major adverse cardiovascular and cerebrovascular events (MACCEs) were compared between groups using Student’s t-test or Chi-squared test. Time-to-event analysis employed Kaplan-Meier/log-rank tests with landmark analysis. Results: The median follow-up time was 1.23 [interquartile range (IQR), 0.33–2.63] years in ChiTTS Registry patients and 2.35 (IQR, 1.68–3.68) years in AMI patients. In contrast to AMI patients, TTS patients presented with more clinical manifestations associated with acute heart failure. TTS patients developed approximately twice as many in-hospital complications as AMI patients (42.2% vs. 20.7%, P<0.001) and experienced significantly more 100-day MACCEs (19.6% vs. 10.8%, P=0.03) and all-cause mortality (17.9% vs. 8.9%, P=0.02). In comparison to AMI patients, the landmark analysis confirmed that TTS patients developed more 100-day MACCEs [hazard ratio (HR) 1.87; 95% confidence interval (CI): 1.03–3.37; log-rank test P=0.04] and all-cause mortality (HR 2.07; 95% CI: 1.10–3.91; log-rank test P=0.02). In contrast, no significant difference was found in long-term MACCEs (HR 0.38; 95% CI: 0.13–1.09; log-rank test P=0.06) and all-cause mortality (HR 0.96; 95% CI: 0.31–2.98; log-rank test P=0.94) between TTS and AMI patients. Conclusions: In comparison to AMI patients, Chinese TTS patients developed more in-hospital complications and had a worse short-term prognosis. The cardiovascular issues in TTS patients underscore the need for effective treatment and personalized strategies to enhance outcomes and mitigate risks.