BACKGROUND: Ethnic disparities have been reported in cardiovascular disease. However, ethnic disparities in takotsubo syndrome (TTS) remain elusive. This study assessed differences in clinical characteristics between Japanese and European TTS patients and determined the impact of ethnicity on in-hospital outcomes. METHODS: TTS patients in Japan were enrolled from 10 hospitals and TTS patients in Europe were enrolled from 32 hospitals participating in the International Takotsubo Registry. Clinical characteristics and in-hospital outcomes were compared between Japanese and European patients. RESULTS: A total of 503 Japanese and 1670 European patients were included. Japanese patients were older (72.6 ± 11.4 years vs. 68.0 ± 12.0 years; p < 0.001) and more likely to be male (18.5 vs. 8.4%; p < 0.001) than European TTS patients. Physical triggering factors were more common (45.5 vs. 32.0%; p < 0.001), and emotional triggers less common (17.5 vs. 31.5%; p < 0.001), in Japanese patients than in European patients. Japanese patients were more likely to experience cardiogenic shock during the acute phase (15.5 vs. 9.0%; p < 0.001) and had a higher in-hospital mortality (8.2 vs. 3.2%; p < 0.001). However, ethnicity itself did not appear to have an impact on in-hospital mortality. Machine learning approach revealed that the presence of physical stressors was the most important prognostic factor in both Japanese and European TTS patients. CONCLUSION: Differences in clinical characteristics and in-hospital outcomes between Japanese and European TTS patients exist. Ethnicity does not impact the outcome in TTS patients. The worse in-hospital outcome in Japanese patients, is mainly driven by the higher prevalence of physical triggers. TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique Identifier: NCT01947621.

1st Department of Cardiology Medical University of Gdansk Gdansk Poland

1st Department of Medicine Faculty of Medicine University Medical Centre Mannheim University of Heidelberg Mannheim Germany

Advanced Heart Failure and Transplantation Center University Medical Center Ljubljana Ljubljana Slovenia

Cardiocenter 3rd Faculty of Medicine Charles University Prague Prague Czech Republic

Center for Cardiology University Medical Center Mainz Cardiology 1 Mainz Germany

Center for Molecular Cardiology Schlieren Campus University of Zurich Zurich Switzerland

Centro Cardiologico Monzino IRCCS Milan Italy

Clinic for Cardiology and Pneumology Goettingen University Goettingen Germany

Department of Biostatistics Epidemiology Biostatistics and Prevention Institute University of Zurich Zurich Switzerland

Department of Cardiac Electrophysiology Helios St Marienberg Hospital Helmstedt Helmstedt Germany

Department of Cardiology and Angiology Hannover Medical School Hannover Germany

Department of Cardiology and Cardiac Imaging Center University Hospital of Rangueil Toulouse France

Department of Cardiology and Catheterization Laboratories Shonankamakura General Hospital Kamakura Japan

Department of Cardiology Basil Hetzel Institute Queen Elizabeth Hospital University of Adelaide Adelaide Australia

Department of Cardiology Charité Universitätsmedizin Berlin Berlin Germany

Department of Cardiology Chiba Emergency Medical Center Chiba Japan

Department of Cardiology Christchurch Hospital Christchurch New Zealand

Department of Cardiology Japanese Red Cross Musashino Hospital Tokyo Japan

Department of Cardiology John Radcliffe Hospital Oxford University Hospitals Oxford UK

Department of Cardiology Kantonsspital Frauenfeld Frauenfeld Switzerland

Department of Cardiology Kantonsspital Lucerne Lucerne Switzerland

Department of Cardiology Kantonsspital St Gallen St Gallen Switzerland

Department of Cardiology Kantonsspital Winterthur Winterthur Switzerland

Department of Cardiology King's College Hospital London UK

Department of Cardiology Leiden University Medical Centre Leiden The Netherlands

Department of Cardiology Medical University Hospital Heidelberg Heidelberg Germany

Department of Cardiology Medical University of Warsaw Warsaw Poland

Department of Cardiology St Luke's International Hospital Tokyo Japan

Department of Cardiology Tokai University School of Medicine Isehara Japan

Department of Cardiology Tokyo Metropolitan Tama Medical Center Tokyo Japan

Department of Cardiology Toranomon Hospital Tokyo Japan

Department of Cardiology University Heart Center University Hospital Zurich Raemistrasse 100 8091 Zurich Switzerland

Department of Cardiology University Hospital Basel Basel Switzerland

Department of Cardiovascular Diseases Mayo Clinic Rochester MN USA

Department of Cardiovascular Medicine Chiba University Graduate School of Medicine Chiba Japan

Department of Cardiovascular Medicine Nippon Medical School Tokyo Japan

Department of General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany

Department of Internal Medicine 1 Cardiology University Hospital Olomouc Olomouc Czech Republic

Department of Internal Medicine 2 Cardiology Medical Center University of Ulm Ulm Germany

Department of Internal Medicine 3 Division of Cardiology Angiology and Intensive Medical Care University Hospital Halle Martin Luther University Halle Wittenberg Halle Germany

Department of Internal Medicine 3 Heart Center University of Cologne Cologne Germany

Department of Internal Medicine B University Medicine Greifswald Greifswald Germany

Department of Internal Medicine Cardiology Heart Center Leipzig University Hospital Leipzig Germany

Department of Internal Medicine Kreiskrankenhaus Wolgast Wolgast Germany

Department of Mathematics and Computer Science University of Bremen Bremen Germany

Deutsches Herzzentrum München Technische Universität München Munich Germany

Division of Cardiology A O U San Luigi Gonzaga Orbassano Turin Italy

Division of Cardiology Antonio Cardarelli Hospital Naples Italy

Division of Cardiology Department of Medical Sciences AOU Citta Della Salute e Della Scienza University of Turin Turin Italy

Division of Cardiology Heart and Vascular Center University of Iowa Iowa City IA USA

Division of Cardiology Kimitsu Central Hospital Kisarazu Japan

Division of Cardiovascular Medicine Department of Medicine College of Medicine University of Florida Gainesville FL USA

DZHK partner site Greifswald Greifswald Germany

DZHK partner site Hamburg Kiel Luebeck Hamburg Germany

DZHK Partner Site Heidelberg Mannheim Mannheim Germany

DZHK Partner Site Munich Heart Alliance Munich Germany

Fondazione Policlinico Universitario A Gemelli IRCCS Roma Italia

Heart and Vascular Centre Bad Bevensen Bad Bevensen Germany

Heart Center Turku University Hospital and University of Turku Turku Finland

Heart Department University Hospital San Giovanni di Dio E Ruggi d'Aragona Salerno Italy

Intensive Coronary Care Unit Moscow City Hospital 1 Named After N Pirogov Moscow Russia

Internal Medicine Cardiology Angiology and Pneumology Magdeburg University Magdeburg Germany

Keck School of Medicine University of Southern California Los Angeles CA USA

Klinik Für Innere Medizin 3 Universitätsklinikum des Saarlandes Homburg Saar Germany

Krankenhaus Maria Hilf Medizinische Klinik Stadtlohn Germany

Local Health Unit n 8 Cardiology Unit Arzignano Vicenza Italy

Royal Brompton and Harefield Hospitals Trust and Imperial College London UK

Santa Maria University Hospital CHULN Center of Cardiology of the University of Lisbon Lisbon School of Medicine Lisbon Academic Medical Center Lisboa Portugal

Section of Cardiac Electrophysiology Department of Medicine University of California San Francisco San Francisco CA USA

Service de Cardiologie Hôpitaux Universitaires de Genève Geneva Switzerland

Structural Interventional Cardiology Careggi University Hospital Florence Italy

TJ Health Partners Heart and Vascular Glasgow KY USA

Universitäres Herzzentrum Regensburg Regensburg Germany

University Hospital for Internal Medicine 3 Medical University Innsbruck Innsbruck Austria

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ClinicalTrials.gov
NCT01947621