AUTHOR=Núñez-Gil Iván J. , Santoro Francesco , Vazirani Ravi , Novo Giuseppina , Blanco-Ponce Emilia , Arcari Luca , Uribarri Aitor , Cacciotti Luca , Guerra Federico , Salamanca Jorge , Musumeci Beatrice , Vedia Oscar , Mariano Enrica , Fernández-Cordón Clara , Caldarola Pasquale , Montisci Roberta , Brunetti Natale Daniele , El-Battrawy Ibrahim , Abumayyaleh Mohammad , Akin Ibrahim , Eitel Ingo , Stiermaier Thomas 

TITLE=Smoking influence in Takotsubo syndrome: insights from an international cohort

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=10

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1282018

DOI=10.3389/fcvm.2023.1282018

ISSN=2297-055X

ABSTRACT=<sec><title>Aims</title><p>To assess the influence of tobacco on acute and long-term outcomes in Takotsubo syndrome (TTS).</p></sec><sec><title>Methods</title><p>Patients with TTS from the international multicenter German Italian Spanish Takotsubo registry (GEIST) were analyzed. Comparisons between groups were performed within the overall cohort, and an adjusted analysis with 1:1 propensity score matching was conducted.</p></sec><sec><title>Results</title><p>Out of 3,152 patients with TTS, 534 (17%) were current smokers. Smoker TTS patients were younger (63 ± 11 vs. 72 ± 11 years, <italic>p</italic> &lt; 0.001), less frequently women (78% vs. 90%, <italic>p</italic> &lt; 0.001), and had a lower prevalence of hypertension (59% vs. 69%, <italic>p</italic> &lt; 0.01) and diabetes mellitus (16% vs. 20%, <italic>p</italic> = 0.04), but had a higher prevalence of pulmonary (21% vs. 15%, <italic>p</italic> &lt; 0.01) and/or psychiatric diseases (17% vs. 12%, <italic>p</italic> &lt; 0.01). On multivariable analysis, age less than 65 years [OR 3.85, 95% CI (2.86–5)], male gender [OR 2.52, 95% CI (1.75–3.64)], history of pulmonary disease [OR 2.56, 95% CI (1.81–3.61)], coronary artery disease [OR 2.35, 95% CI (1.60–3.46)], and non-apical ballooning form [OR 1.47, 95% CI (1.02–2.13)] were associated with smoking status. Propensity score matching (PSM) 1:1 yielded 329 patients from each group. Smokers had a similar rate of in-hospital complications but longer in-hospital stays (10 vs. 9 days, <italic>p</italic> = 0.01). During long-term follow-up, there were no differences in mortality rates between smokers and non-smokers (5.6% vs. 6.9% yearly in the overall, <italic>p</italic> = 0.02, and 6.6%, vs. 7.2% yearly in the matched cohort, <italic>p</italic> = 0.97).</p></sec><sec><title>Conclusions</title><p>Our findings suggest that smoking may influence the clinical presentation and course of TTS with longer in-hospital stays, but does not independently impact mortality.</p></sec>