F-73 | Electrocardiographic Phenotype and Use of Coronary Angiography in Takotsubo Cardiomyopathy

Background: Takotsubo cardiomyopathy (TC) frequently presents with electrocardiographic (EKG) abnormalities that mimic acute coronary syndromes, often leading to invasive coronary angiography.STsegment elevation (STE), in particular, commonly triggers emergent catheterization despite the absence of obstructive coronary disease.Whether outcomes in TC differ by EKG phenotype or use of invasive evaluation remains unclear.We assessed the association of STE presentation and coronary angiography with in-hospital and long-term clinical outcomes.Methods: We conducted a retrospective multicenter cohort study of patients admitted with TC identified using ICD-10 codes across a regional hospital system.Diagnoses were confirmed by chart review.Patients were stratified by admission EKG pattern (STE vs non-STE) and by management strategy (coronary angiography vs no angiography).Outcomes included ICU admission, length of stay (LOS), inhospital mortality, in-hospital stroke or transient ischemic attack (TIA), and 30-day and 1-year mortality, stroke/TIA, and rehospitalization.Continuous variables were analyzed using nonparametric tests and categorical variables using Fisher's exact test.Results: Among 114 patients with TC, 21 (18.4%)presented with STE.Coronary angiography was performed more frequently in patients with STE.Both STE presentation and angiography were associated with higher ICU admission rates, reflecting greater initial acuity.However, neither STE nor angiography was associated with longer LOS or increased adverse events.There were no significant differences in inhospital mortality or stroke/TIA.Similarly, 30-day and 1-year mortality, stroke/TIA, and rehospitalization rates did not differ by EKG phenotype, angiography status, or their combination (all p > 0.10).Conclusions: STE presentation and use of coronary angiography in TC were associated with higher initial care intensity but not worse short-or long-term outcomes.These findings suggest STE reflects phenotypic variation rather than increased risk and support the safety of invasive evaluation in TC presenting as STEMI.