TY - JOUR
T1 - Sex Differences in the Clinical Outcomes of Patients With Takotsubo Stress Cardiomyopathy
T2 - A Meta-Analysis of Observational Studies
AU - Abusnina, Waiel
AU - Elhouderi, Eiman
AU - Walters, Ryan W.
AU - Al-Abdouh, Ahmad
AU - Mostafa, Mostafa R.
AU - Liu, John L.
AU - Mazozy, Ruqayah
AU - Mhanna, Mohammed
AU - Ben-Dor, Itsik
AU - Dufani, Jalal
AU - Kabach, Amjad
AU - Michos, Erin D.
AU - Aboeata, Ahemd
AU - Mamas, Mamas A.
N1 - Publisher Copyright:
© 2023 Elsevier Inc.
PY - 2024/1/15
Y1 - 2024/1/15
N2 - The incidence of takotsubo stress cardiomyopathy (TSCM) in males is low compared with females. Gender-based differences in clinical outcomes of TSCM are not well characterized. The aim of this meta-analysis was to analyze whether gender-based differences are observed in TSCM clinical outcomes. A comprehensive literature search of PubMed, Embase, Cochrane Library database, and Web of Science was performed from inception to June 20, 2022, for studies comparing the clinical outcomes between male and female patients with TSCM. The primary outcome of interest was in-hospital all-cause mortality and cardiogenic shock. The secondary outcomes were cardiovascular mortality, receipt of mechanical ventilation, intra-aortic balloon pump, occurrence of ventricular arrhythmia, and left ventricular thrombus. A random-effects model was used to calculate the risk ratios (RR) and confidence intervals (CI). Heterogenicity was assessed using the Higgins I2 index. Twelve observational studies involving 51,213 patients (4,869 males and 46,344 females) were included in the meta-analysis. Male gender was associated with statistically significant higher in-hospital all-cause mortality compared with females in patients with TSCM (RR 2.17, 95% CI 1.77 to 2.67, p <0.001). The rate of cardiogenic shock was significantly higher in males with TSCM compared with females (RR 1.66, 95% CI 1.29 to 2.12, p <0.001). Our meta-analysis showed a difference in the clinical outcomes of TSCM between men and women. Male gender was associated with a two-fold greater in-hospital all-cause mortality risk compared with female gender. The higher mortality risk associated with male gender deserves further study, particularly whether it represents later recognition of the condition and disparities in treatments.
AB - The incidence of takotsubo stress cardiomyopathy (TSCM) in males is low compared with females. Gender-based differences in clinical outcomes of TSCM are not well characterized. The aim of this meta-analysis was to analyze whether gender-based differences are observed in TSCM clinical outcomes. A comprehensive literature search of PubMed, Embase, Cochrane Library database, and Web of Science was performed from inception to June 20, 2022, for studies comparing the clinical outcomes between male and female patients with TSCM. The primary outcome of interest was in-hospital all-cause mortality and cardiogenic shock. The secondary outcomes were cardiovascular mortality, receipt of mechanical ventilation, intra-aortic balloon pump, occurrence of ventricular arrhythmia, and left ventricular thrombus. A random-effects model was used to calculate the risk ratios (RR) and confidence intervals (CI). Heterogenicity was assessed using the Higgins I2 index. Twelve observational studies involving 51,213 patients (4,869 males and 46,344 females) were included in the meta-analysis. Male gender was associated with statistically significant higher in-hospital all-cause mortality compared with females in patients with TSCM (RR 2.17, 95% CI 1.77 to 2.67, p <0.001). The rate of cardiogenic shock was significantly higher in males with TSCM compared with females (RR 1.66, 95% CI 1.29 to 2.12, p <0.001). Our meta-analysis showed a difference in the clinical outcomes of TSCM between men and women. Male gender was associated with a two-fold greater in-hospital all-cause mortality risk compared with female gender. The higher mortality risk associated with male gender deserves further study, particularly whether it represents later recognition of the condition and disparities in treatments.
KW - broken heart syndrome
KW - gender differences
KW - gender disparities
KW - stress cardiomyopathy
KW - takotsubo syndrome
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U2 - 10.1016/j.amjcard.2023.10.066
DO - 10.1016/j.amjcard.2023.10.066
M3 - Article
C2 - 37923154
AN - SCOPUS:85179982453
SN - 0002-9149
VL - 211
SP - 316
EP - 325
JO - American Journal of Cardiology
JF - American Journal of Cardiology
ER -