Abstract Body (Do not enter title and authors here): Background:
High prevalence of psychiatric disorders (PD) is seen in Takotsubo cardiomyopathy (TC). Existing literature presents conflicting results but often identifies worse outcomes in patients with PD who develop TC. Primary limitations of those studies were relatively small sample sizes and insufficient matching for confounders. Therefore, we used a global database to determine differences in outcomes in TC patients with and without PD.

Methods:
We queried the TriNeTX Global collaborative network for adults diagnosed with TC between 2013 and 2023. We excluded patients with confounding diagnoses occurring 5 days before or after TC diagnosis and created two cohorts based on PD diagnosis. ICD-10 codes for PD included were: psychotic, mood and anxiety disorders. Propensity score matching (PSM) was conducted for over 50 covariates. After PSM, logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals. The primary endpoints were all-cause mortality, 4-point MACE and ICU admissions at 30 days, 90 days and 1 year. Acute appendicitis was used as a falsification endpoint.

Result:
The sample population had 10864 patients in the cohort with diagnosed TC and PD (Cohort 1) and 11,997 patients with TC without PD (Cohort 2). Before propensity score matching (PSM), Cohort 1 had significantly increased odds of ICU admissions (OR 1.32, 95%CI, 1.22-1.43) and 4-point MACE (OR 1.34, 95%CI, 1.26-1.44) but not all-cause mortality (OR 0.98, 95%CI, 0.88-1.09) at 30 days [Table 1]. After propensity score matching (PSM), both cohorts had 7,074 patients. Analysis post-PSM showed Cohort 1 had significantly lower odds of all primary outcomes compared to Cohort 2 at 30 days: All-cause mortality (OR 0.75; 95%CI, 0.66-0.86), 4 point MACE (OR 0.86; 95%CI, 0.79-0.94), and ICU admission (OR 0.88; 95%CI 0.80-0.97). These lower odds persisted at 90 days and 1 year.

Conclusion:
After extensive propensity score matching to eliminate confounders, there are reduced odds of 4-point MACE, all-cause mortality, cardiogenic shock and cardiac arrest in TC with PD cohort suggesting that patients with PD and TC have better cardiovascular outcomes if appropriately matched to a cohort with similar baseline characteristics.