Background: Short- and long-term prognosis of Takotsubo syndrome (TTS) according to age is controversial. Aim of the study was to evaluate age-related differences and prognostic implications among TTS patients.

Methods: In total, 2,492 consecutive TTS patients enrolled in an international  registry were stratified into four groups (<45 years, 45-64 years, 65-74 years and ≥75 years). The median long-term follow-up was 480 days (interquartile range [IQR] 83-1510 days). The primary outcome was all cause mortality (in- and out hospital mortality). Secondary endpoint were TTS related in-hospital complications.

Results:  Of 2479 patients, 58 (2.3%) were <45 years, 625 (25.1%) were 45-64 years, 733 (29.4%) were 65-74 years and 1063 (42.6%) were ≥75 years.

Young patients (<45 years) had a higher prevalence of male sex (24.1% vs 12.6% vs 9.7% vs 11.4%, p<0.01), physical triggers (46.6% vs 27.5%, 33.9% and 38.4%, p<0.01) and apical sparing forms of TTS (25.9% vs 23.7%, 12.7% and 9%, p<0.01), compared to the groups 45-64 years, 65-74 years and ≥75 years. During hospitalization, young patients experienced a higher rate of in-hospital complications (32.8% vs 23.4, 27.4% and 31.9%, p=0.01), but in-hospital mortality was higher in the older group (0%, 1.6%, 2.9% and 5%, p=0.001).

Long-term mortality was significantly higher in the older-age cohort compared to other groups (5.6%, 6.4%, 11.3% and 22.3%, log-rank p<0.001).

Conclusions: Young TTS patients have a typical phenotype featured by a higher prevalence of male sex, apical sparing ballooning patterns and a higher rate of in-hospital complications. However, in-hospital and long-term mortality is significantly lower compared to older age groups.