Sex differences in clinical characteristics and outcomes of Takotsubo syndrome in an east asian population

Background Takotsubo syndrome (TTS) predominantly affects elderly women, with men accounting for approximately 10% of cases in Western registries. Male patients are often reported to present with more severe physical stressors and worse outcomes. While large European registries such as InterTAK have described sex-related differences, comprehensive data in East Asian populations remain limited. Purpose To investigate sex differences in clinical characteristics, in-hospital events, and long-term outcomes in an East Asian TTS cohort. Methods We retrospectively analyzed 447 consecutive patients diagnosed with TTS either at admission or during hospitalization for other conditions. Clinical characteristics, triggers, comorbidities, cardiovascular events (including lethal arrhythmias and cardiogenic shock), in-hospital mortality, and long-term survival were compared between male and female patients. Results Among 447 patients, 82 (22.5%) were male. Mean age was comparable between sexes (74 years in both groups, p=0.83). Males had significantly higher smoking rates (48.6% vs. 16.2%, p<0.001) and lower prevalence of emotional triggers (4.9% vs. 16.7%, p=0.005). Comorbidities were more common in men, including cancer (36.5% vs. 19.5%, p=0.001) and cardiovascular disease (26.8% vs. 15.6%, p=0.024). In-hospital mortality was significantly higher in men (37.8% vs. 19.5%, p=0.001). The incidence of lethal ventricular arrhythmias and cardiogenic shock was also higher in men. Long-term survival was significantly worse in male patients (HR 0.37, 95% CI 0.24–0.57, log-rank p<0.001). Conclusions In this East Asian cohort, men accounted for a higher proportion of TTS cases than previously reported in Western registries and exhibited significantly worse short- and long-term outcomes. These findings underscore important sex-related differences in TTS presentation and prognosis in East Asian populations.Fifigure1figure2