An 81-year-old woman with emotionally-induced takotsubo cardiomyopathy developed a fatal left ventricular (LV) apical rupture. During the hospitalization persistent ST-segment elevation with no electrocardiographic time evolution was observed on the ECG, characteristic for takotsubo cardiomyopathy. Histopathologically, transmural myocardial necrosis with hemorrhage was found at the rupture site, but there were foci of coagulation and contraction band necrosis with mononuclear lymphocyte infiltrations in other heart regions, and the intensity and distribution of these pathological changes corresponded to the distribution of the LV contraction abnormalities seen on ventriculography. The article concludes that: the LV functional disorder in takotsubo cardiomyopathy may be caused by distracted foci of coagulation and contraction band necrosis in the myocardium; contraction band necrosis (a sign of catecholamine cardiotoxicity) may reflect the sympathetic hyperactivity in this disease; persistent myocardial damage expressed by persistent ST-segment elevation without an electrocardiographic time evolution should be carefully observed with sequential echocardiographic examinations because of the possibility of cardiac rupture. (Circ J 2007; 71: 982 - 985)

Background: There are no data regarding the mortality rate, risks and benefits of particular reperfusion methods and pharmacological treatment complications in patients aged over 100 years with acute coronary syndromes. We sought to assess the treatment of myocardial infarction (MI) in patients older than 100 years and to determine prognostic factors for this group. Methods: Among the 716,566 patients recorded between 2003 and 2018 in the Polish Registry of Acute Coronary Syndromes, 104 patients aged ≥100 with MI were included. The patients were categorized into two groups: group 1 received conservative treatment (64 patients), and group 2 received invasive strategy (40 patients). Results: The frequencies of in-hospital mortality, MI and stroke were similar in both arms. No difference in the frequency of the combined endpoint (death, reinfarction, stroke) was noted. Invasive treatment was more advantageous for 12-month outcomes; 50 patients in group 1 (79%) and 23 patients in group 2 (57.50%) died (p = 0.017). The multivariate analysis identified the lower left ventricular ejection fraction (EF) (Hazard Ratio (HR) = 0.96; 95% Confidence Interval (CI): 0.94–0.99; p = 0.012), lack of coronary angiography (HR = 0.49; 95% CI: 0.24–0.99; p = 0.048) and cardiac arrest (HR = 4.61; 95% CI: 1.64–12.99; p = 0.0038) as predictors of 12-month mortality in this group. Conclusions: Invasive MI treatment may be beneficial for selected very old patients.