Aims Despite increasing research efforts, the prognostic consequences of takotsubo cardiomyopathy (TTC) remain largely unknown. The aim of this study was therefore to compare the long‐term mortality rate of TTC patients with high‐risk patients presenting with ST‐segment elevation myocardial infarction (STEMI). Methods and results A total of 286 patients with TTC were matched for age and gender with 286 STEMI patients. Outcome was obtained with a standardized telephone follow‐up. The primary analysis determined long‐term mortality. A secondary analysis was performed evaluating 28‐day and 1‐year mortality. Follow‐up was available for 96% of patients after a mean of 3.8 ± 2.5 years. In TTC patients, long‐term mortality was significantly higher compared with the matched STEMI cohort [24.7% vs. 15.1%, hazard ratio (HR) 1.58, 95% confidence interval (CI) 1.07–2.33; P = 0.02]. There was no significant difference in the rates of 28‐day (5.5% vs. 5.7%, HR 0.96, 95% CI 0.47–1.94; P = 0.91) and 1‐year mortality (12.5% vs. 9%, HR 1.42, 95% CI 0.85–2.38; P = 0.18). In multivariable regression analysis, male sex, a high Killip class on admission, and diabetes mellitus were identified as independent predictors of mortality in TTC patients. A risk score consisting of these factors showed a higher mortality with an increasing number of risk factors. Conclusion Mortality rates in TTC patients are higher than previously expected and long‐term mortality exceeded that of patients with STEMI. A simple risk score may provide an approach to identify high‐risk patients and predict clinical prognosis.

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Die Unsicherheit über die Wirkungsdauer einer antenatalen Glukokortikoidtherapie (ANC) zur Lungenreifung veranlasst einen groûen Teil der Geburtshelfer zu wiederholten Applikationen. Tierversuche, aber auch Untersuchungen aus dem Bereich der Humanmedizin, lassen es möglich erscheinen, dass die Morbidität der Neonaten durch die wiederholte Kortisongabe zunimmt: Erhöhte neonatale Mortalität, ein geringeres Geburtsgewicht, Beeinträchtigung der mentalen und psychomotorischen Entwicklung, Anstieg der Infektmorbidität von Mutter und Kind, Beeinflussung der intrauterinen Programmierung durch Modifikation der hypothalamo-pituitär-adrenalen Achse mit Manifestation von Diabetes und Bluthochdruck im späteren Leben des Kindes. Bei Auswertung der aktuellen Literatur können diese diskutierten Komplikationen einer wiederholten ANC-Gabe jedoch keinesfalls als bewiesen gelten. Da andererseits die wiederholte ANC-Applikation lediglich mit einer unterschiedlich ausgepräg-ten Verminderung des Atemnotsyndroms korreliert, gibt es auch für die routinemäûige multiple Wiederholung der Steroidgabe keine wissenschaftliche Begründung. Bis die Ergebnisse gröûerer prospektiver, randomisierter Studien vorliegen, sollte jeder Schwangeren mit signifikanten Frühgeburtsbestrebungen zwischen der 24. und der 34. Schwangerschaftswoche (SSW) ein Zyklus z. B. Betamethason (2 12 mg im Abstand von 24 Stunden) appliziert werden. Aufgrund bisheriger Daten kann allen- AbstractThe discussion on the application of multiple versus single courses of antenatal corticosteroids (ANC) for the prevention of respiratory distress syndrome (RDS) in newborns is still controversial. Since the benefits of ANC have been shown to be most significant within 7 to 10 days after treatment, many obstetricians tend to treat women with repeated courses of ANC if the risk of premature delivery persists. However, data from animal as well as from clinical studies suggest detrimental effects of multiple courses of ANC: an increase of neonatal mortality, low birth weight, retardation of mental, and psychomotoric development, an increase in infectious morbidity of the mother and the newborn, alterations of intra-uterine programming by modification of the hypothalamic-pituitary-adrenal axis with the consequence of an increased rate of diabetes and hypertension in later life. However, a detailed review of the literature fails to prove a causal relationship between multiple courses of ANC and the complications mentioned above. Conversely, only gradual decreases in the severity of RDS do not justify routine application of repeated courses of ANC. Until publication of the results of larger prospective randomised controlled trials, each pregnant woman at significant risk for premature delivery (24 ± 34 weeks of gestation) should receive a single course of ANC (e.g. betamethasone, 2 12 mg in a 24-hour interval). Based on the data pubÜbersicht

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