Skip to main content

Research Repository

Advanced Search

Sex Differences in the Clinical Outcomes of Patients with Takotsubo Stress Cardiomyopathy: A Meta-analysis of Observational Studies.

Abusnina, Waiel; Elhouderi, Eiman; Walters, Ryan W; Al-Abdouh, Ahmad; Mostafa, Mostafa R; Ben-Dor, Itsik; Dufani, Jalal; Mazozy, Ruqayah; Michos, Erin D; Aboeata, Ahemd; Mamas, Mamas A


Waiel Abusnina

Eiman Elhouderi

Ryan W Walters

Ahmad Al-Abdouh

Mostafa R Mostafa

Itsik Ben-Dor

Jalal Dufani

Ruqayah Mazozy

Erin D Michos

Ahemd Aboeata


The incidence of takotsubo stress cardiomyopathy (TSCM) in males is low compared to females. Sex-based differences in clinical outcomes of TSCM are not well characterized. The aim of this meta-analysis was to analyze whether sex-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 males versus females in 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, and 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 I index. Twelve observational studies involving 51,213 patients (4,869 males, and 46,344 females) were included in the meta-analysis. Male sex was associated with statistically significant higher in-hospital all-cause mortality when compared to females in patients with TSCM (RR 2.17; 95% CI 1.77-2.67; P < 0.001) The rate of cardiogenic shock was significantly higher in males with TSCM as compared to females (RR 1.66; 95% CI 1.29-2.12; P < 0.001). Our meta-analysis showed a difference in the clinical outcomes of TSCM between men and women. Males sex was associated with a two-fold greater in-hospital all-cause mortality risk compared to female sex. The higher mortality risk associated with male sex deserves further study, and particularly whether it represents later recognition of the condition and disparities in treatments. [Abstract copyright: Copyright © 2023. Published by Elsevier Inc.]

Journal Article Type Article
Acceptance Date Oct 24, 2023
Online Publication Date Nov 1, 2023
Deposit Date Nov 27, 2023
Journal The American journal of cardiology
Print ISSN 0002-9149
Publisher Elsevier
Peer Reviewed Peer Reviewed
Pages S0002-9149(23)01236-5
Keywords stress cardiomyopathy, takotsubo syndrome, gender disparities, sex differences, broken heart syndrome
Publisher URL