Article Text

other Versions

Download PDFPDF
Original research
Survival and risk of recurrence of takotsubo syndrome
  1. Christopher Lau1,
  2. Sarah Chiu1,
  3. Rohith Nayak1,
  4. Bryan Lin2,
  5. Ming-Sum Lee3
  1. 1Internal Medicine, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
  2. 2Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
  3. 3Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
  1. Correspondence to Dr Ming-Sum Lee, Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California 90027, USA; mingsum.lee{at}


Objective The goal of this study is to evaluate the long-term outcomes of patients with takotsubo syndrome and assess factors associated with death or recurrence.

Methods This is a retrospective population-based cohort study of consecutive patients who presented to an integrated health system in Southern California with takotsubo syndrome between 2006 and 2016. Medical records were manually reviewed to confirm diagnosis and to identify predisposing factors, medication treatment and long-term outcomes. Factors associated with death or recurrent takotsubo syndrome were tested using Cox regression models.

Results Between 2006 and 2016, there were 519 patients with a confirmed diagnosis of takotsubo syndrome. Patients were followed for 5.2 years (IQR 3.0–7.2). During the follow-up period, 39 (7.5%) had recurrent takotsubo syndrome and 84 (16.2%) died. In multivariate modelling, factors associated with higher risk of recurrence or death were age (HR 1.56 per 10-year increase, 95% CI 1.29 to 1.87), male sex (HR 2.52, 95% CI 1.38 to 4.60), diabetes (HR 1.6, 95% CI 1.06 to 2.43), pulmonary disease (HR 2.0, 95% CI 1.37 to 2.91) and chronic kidney disease (HR 1.58, 95% CI 1.01 to 2.47). Treatment with beta-blockers were associated with lower risk of recurrence or death (HR 0.46, 95% CI 0.29 to 0.72). No association was observed between treatment with ACE inhibitors or angiotensin-receptor blockers and recurrence or death (HR 0.92, 95% CI 0.59 to 1.42).

Conclusions Recurrent takotsubo syndrome occurred in a minor subset of patients. Treatment with beta-blocker was associated with higher event-free survival.

  • myocardial disease

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors All of the authors contributed to study planning, data collection, data reporting and manuscript writing. CL and M-SL are responsible for the overall content of this manuscript as guarantors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The present study was approved by the Kaiser Permanente Southern California Institutional Review Board. A waiver of informed consent was obtained because of the observational nature of the study.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. The data that support the findings of this study are available on reasonable request (

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.