Huang Yuxi, Lyu Lingchun, Tao Yuan, Lei Juan, Wei Yulin, Wu Liwen, Xu Mei, Liu Yusheng, Jiang Lingzhi, Sun Zhongxia, Ding Yongmin, Miao Pengfei, Guan Qianglin, Lv Feng, Pan Cunxue, Lu Chenying, Chen Yuyi, Chong Tou Kun, Liu Kan, Chen Jian
Department of Cardiovascular Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, China.
Department of Cardiology, Lishui Hospital of Zhejiang University School of Medicine, Lishui, China.
Cardiovasc Diagn Ther. 2025 Jun 30;15(3):563-573. doi: 10.21037/cdt-2025-8. Epub 2025 Jun 25.
Takotsubo syndrome (TTS) differs significantly from acute myocardial infarction (AMI) in clinical features and pathological mechanisms, but evidence in Asian populations remains limited. The aim of this study is to compare clinical features and outcomes between patients with TTS and AMI in the first Chinese registry of TTS (ChiTTS Registry, ChiCTR1900026725).
In this multicenter 6-year retrospective cohort study (February 2016-June 2022), a total of 116 consecutive TTS patients diagnosed according to the international Takotsubo diagnostic criteria and 232 age- and sex-matched AMI patients (1:2 ratio) meeting the 2023 European Society of Cardiology guidelines criteria were enrolled from 10 tertiary medical centers across China. Clinical characteristics, in-hospital outcomes, and major adverse cardiovascular and cerebrovascular events (MACCEs) were compared between groups using Student's -test or Chi-squared test. Time-to-event analysis employed Kaplan-Meier/log-rank tests with landmark analysis.
The median follow-up time was 1.23 [interquartile range (IQR), 0.33-2.63] years in ChiTTS Registry patients and 2.35 (IQR, 1.68-3.68) years in AMI patients. In contrast to AMI patients, TTS patients presented with more clinical manifestations associated with acute heart failure. TTS patients developed approximately twice as many in-hospital complications as AMI patients (42.2% 20.7%, P<0.001) and experienced significantly more 100-day MACCEs (19.6% 10.8%, P=0.03) and all-cause mortality (17.9% 8.9%, P=0.02). In comparison to AMI patients, the landmark analysis confirmed that TTS patients developed more 100-day MACCEs [hazard ratio (HR) 1.87; 95% confidence interval (CI): 1.03-3.37; log-rank test P=0.04] and all-cause mortality (HR 2.07; 95% CI: 1.10-3.91; log-rank test P=0.02). In contrast, no significant difference was found in long-term MACCEs (HR 0.38; 95% CI: 0.13-1.09; log-rank test P=0.06) and all-cause mortality (HR 0.96; 95% CI: 0.31-2.98; log-rank test P=0.94) between TTS and AMI patients.
In comparison to AMI patients, Chinese TTS patients developed more in-hospital complications and had a worse short-term prognosis. The cardiovascular issues in TTS patients underscore the need for effective treatment and personalized strategies to enhance outcomes and mitigate risks.
应激性心肌病（TTS）在临床特征和病理机制上与急性心肌梗死（AMI）有显著差异，但亚洲人群中的相关证据仍然有限。本研究旨在比较中国首个应激性心肌病注册研究（ChiTTS注册研究，ChiCTR1900026725）中应激性心肌病患者和急性心肌梗死患者的临床特征及预后。
在这项为期6年的多中心回顾性队列研究（2016年2月至2022年6月）中，从中国10家三级医疗中心连续纳入了116例根据国际应激性心肌病诊断标准确诊的应激性心肌病患者，以及232例年龄和性别匹配的符合2023年欧洲心脏病学会指南标准的急性心肌梗死患者（比例为1:2）。采用Student's t检验或卡方检验比较两组的临床特征、住院结局及主要不良心血管和脑血管事件（MACCE）。生存分析采用Kaplan-Meier/log-rank检验及界标分析。
ChiTTS注册研究患者的中位随访时间为1.23年[四分位数间距（IQR），0.33 - 2.63年]，急性心肌梗死患者为2.35年（IQR，1.68 - 3.68年）。与急性心肌梗死患者相比，应激性心肌病患者出现更多与急性心力衰竭相关的临床表现。应激性心肌病患者的住院并发症发生率约为急性心肌梗死患者的两倍（42.2%对20.7%，P<0.001），100天MACCE发生率显著更高（19.6%对10.8%，P = 0.03），全因死亡率也更高（17.9%对8.9%，P = 0.02）。与急性心肌梗死患者相比，界标分析证实应激性心肌病患者发生100天MACCE的风险更高[风险比（HR）1.87；95%置信区间（CI）：1.03 - 3.37；log-rank检验P = 0.04]，全因死亡率也更高（HR 2.07；95% CI：1.10 - 3.91；log-rank检验P = 0.02）。相比之下，应激性心肌病患者和急性心肌梗死患者在长期MACCE（HR 0.38；95% CI：0.13 - 1.09；log-rank检验P = 0.06）和全因死亡率（HR 0.96；95% CI：0.31 - 2.98；log-rank检验P = 0.94）方面无显著差异。
与急性心肌梗死患者相比，中国应激性心肌病患者的住院并发症更多，短期预后更差。应激性心肌病患者的心血管问题凸显了采取有效治疗和个性化策略以改善结局和降低风险的必要性。
