Age‐related differences in cardiogenic shock secondary to Takotsubo syndrome

Background Age‐related differences in Takotsubo Syndrome (TTS) have been described, but there is limited information regarding TTS patients who develop cardiogenic shock (CS). Methods and Results We analysed data from 408 CS‐TTS patients in the RETAKO registry. Patients were stratified into three age groups: ≤50 years (9%), 51–74 years (48%), and ≥75 years (43%). In the youngest group, compared to the middle‐aged and the oldest groups, patients were more likely to be male (35% vs. 16% and 14%, p = .01), have a physical trigger (65% vs. 43% and 49%, p = .04), exhibit atypical echocardiographic patterns (27% vs. 11% and 11%, p = .02), and experienced a higher incidence of ventricular arrhythmias (24% vs. 8% and 7%, p = .01). In‐hospital mortality rates were 5% in younger patients, 12% in middle‐aged patients, and 15% in older patients ( p = .15). Older age independently predicted both in‐hospital mortality (OR 2.33, 95% CI 1.05–5.17; reference: middle‐aged) and 5‐year mortality (HR 3.69, 95% CI 1.77–7.67), regardless of shock severity. Conclusions In CS‐TTS, younger patients exhibit distinct clinical features but have better outcomes. Older age is associated with higher in‐hospital and long‐term mortality, regardless of comorbidities and shock severity. These findings underscore the need for age‐specific management strategies and further research into the mechanisms underlying age‐related differences in CS‐TTS.