Key result
Admission ST-segment elevation in Takotsubo syndrome is linked to ~53% higher 1-year mortality.
Why the study?
ECG abnormalities are common at presentation in Takotsubo syndrome and may reflect underlying disease severity, but the prognostic significance of distinct ischemic ECG patterns at admission for all-cause and cardiovascular mortality remained incompletely understood.
Does the presence of distinct ischemic ECG patterns at admission identify Takotsubo syndrome patients at higher risk of 1-year all-cause and cardiovascular mortality?
Cohort (n=1,244)
Yes
Does the presence of distinct ischemic ECG patterns at admission identify Takotsubo syndrome patients at higher risk of 1-year all-cause and cardiovascular mortality?
In patients presenting with Takotsubo syndrome, ST-segment elevation on the admission ECG independently predicts a higher 1-year risk of both all-cause and cardiovascular mortality, aiding in early risk stratification.
ST-segment elevation may support risk stratification in Takotsubo syndrome; leaves open whether ECG-guided interventions improve outcomes.
Background Takotsubo syndrome (TTS) is a reversible acute heart failure syndrome. Electrocardiographic (ECG) abnormalities are common at presentation and may reflect underlying disease severity, but their prognostic significance remains incompletely understood. Purpose We aimed to determine whether distinct ischemic ECG patterns at admission identify TTS patients at higher risk of all-cause and cardiovascular mortality. Methods In this nationwide, register-based cohort study, we included all patients with a first-time TTS diagnosis between 2008 and 2021 who had an ECG recorded within 24 hours of admission. Patients were stratified by ECG pattern: ST-segment elevation, ST-segment depression, T-wave inversion, or no ischemic changes. The primary outcome was 1-year all-cause mortality; cardiovascular death was assessed as a secondary outcome. Cox regression models were adjusted for age, sex, diabetes, chronic obstructive pulmonary disease, atrial fibrillation, acute coronary syndrome, hypercholesterolemia, and cancer, with death from other causes treated as a competing risk. Results A total of 1,244 patients were included (mean age 70.8 years; 89.1% women) and stratified by ECG pattern as follows: no ischemic changes (n = 707, 56.8%), ST-segment elevation (n = 226, 18.2%), ST-segment depression (n = 95, 7.6%), and T-wave inversion (n = 216, 17.4%). One-year all-cause mortality was highest among patients with ST-segment elevation (15.0%) compared with no ischemic changes (7.6%), T-wave inversion (6.5%), and ST-segment depression (5.3%). After adjustment, ST-segment elevation was independently associated with a significantly increased risk of all-cause mortality (HR 1.53, 95% CI 1.19–1.96) whereas ST-segment depression and T-wave inversion were not. Cardiovascular death occurred infrequently but was more common among patients with ST-segment elevation. In adjusted analyses, patients with ST-segment elevation had a significantly increased risk of cardiovascular death (HR 2.65, 95% CI 1.16-5.70) compared with those without ST-segment elevation. Conclusions ST-segment elevation on admission ECG identifies TTS patients at higher risk of both all-cause and cardiovascular mortality, highlighting its potential role in risk stratification and guiding closer monitoring and management.Figure 1Figure 2
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Agam et al. (2026) conducted a cohort in Takotsubo syndrome (n=1,244). ST-segment elevation on admission ECG vs. No ischemic ECG changes was evaluated on 1-year all-cause mortality (HR 1.53, 95% CI 1.19-1.96). ST-segment elevation on admission ECG in Takotsubo syndrome was associated with increased 1-year all-cause mortality vs no ischemic changes (15.0% vs 7.6%; HR 1.53, 95% CI 1.19-1.96).
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