Differences in Clinical Features and In-Hospital Outcomes of Older Adults with Tako-Tsubo Cardiomyopathy

Objectives To describe the clinical characteristics and in-hospital outcomes of older adults with tako-tsubo cardiomyopathy (TTC). Design Partially retrospective, partially prospective observational study. Setting Eleven Italian referral cardiac centers included in the Tako-tsubo Italian Network. Participants One hundred ninety consecutive individuals with TTC (92.1% female, mean age 66) were divided into three groups according to age (<65, n = 78; 65-74, n = 61; ≥75, n = 51). Measurements Clinical findings and in-hospital outcomes were evaluated in each group. Results Participants aged 65 and older had a greater prevalence of hypertension (P =.001) and a lower glomerular filtration rate (P <.001), and those aged 65 to 74 had a greater prevalence of psychiatric disorders (P =.01), ST-segment elevation on admission (P =.01) and a cerebrovascular disease (P =.003) than those younger than 65. Despite similar left ventricular ejection fraction (LVEF) on admission (P =.26), the oldest group had a lower LVEF at discharge (P =.03). Inotropic agents were used more frequently in older adults (P =.03). In-hospital composite adverse events (all-cause death, acute heart failure, life-threatening arrhythmias, stroke, and cardiogenic shock; P =.03) and overall complications (P =.004) were more common in participants aged 75 and older. Overall in-hospital mortality was low (2.8%) but was more prevalent in participants aged 75 and older (6.3%). On multivariate analysis, age of 75 and older (hazard ratio (HR) = 2.45, 95% confidence interval (CI) = 1.28-5.82, P =.04) and LVEF on admission (HR = 0.874, 95% CI = 0.81-0.95, P <.001) were the only independent predictors of in-hospital adverse events. Conclusion The clinical profile of participants aged 75 and older with TTC was different from that of those younger than 75 with TTC, and they had a higher in-hospital complication rate. © 2011, The American Geriatrics Society.