Prevalence and Prognostic Impact of Diabetes in Takotsubo Syndrome: Insights From the International, Multicenter GEIST Registry

OBJECTIVEIn view of low prevalence rates, diabetes is discussed as a protective factor for theoccurrence of Takotsubo syndrome (TTS). Furthermore, it was associated with improvedoutcome in a small single-center analysis. Therefore, this study assessed theprevalence and prognostic relevance of concomitant diabetes in TTS.RESEARCH DESIGN AND METHODSAtotal of 826 patients with TTSwere enrolled in an international,multicenter, registrybasedstudy (eight centers in Italy and Germany). All-cause mortality was comparedbetween patients with diabetes and patients without diabetes, and the independentpredictive value of diabetes was evaluated in multivariate regression analysis.RESULTSThe prevalence of diabetes was 21.1% (n = 174). TTS patients with diabetes wereolder (P < 0.001), were more frequentlymale (P = 0.003), had a higher prevalence ofhypertension (P < 0.001), physical triggers (P = 0.041), and typical apical ballooning(P = 0.010), had a lower left ventricular ejection fraction (P = 0.008), had a higher rateof pulmonary edema (P = 0.032), and had a longer hospital stay (P = 0.009).However,28-day all-cause mortality did not differ between patientswith diabetes and patientswithout diabetes (6.4%vs. 5.7%; hazard ratio [HR] 1.11 [95% CI 0.55–2.25]; P =0.772).Longer-term follow-up after a median of 2.5 years revealed a significantly highermortality among TTS patients with diabetes (31.4% vs. 16.5%; P < 0.001), and multivariateregression analysis identified diabetes as an independent predictor of adverseoutcome (HR 1.66 [95% CI 1.16–2.39]; P = 0.006).CONCLUSIONSDiabetes is not uncommon in patients with TTS, is associated with increased longertermmortality rates, and is an independent predictor of adverse outcome irrespectiveof additional risk factors.