BACKGROUND: Secondary Takotsubo syndrome (TTS) differs from primary TTS in terms of clinical characteristics, management, and prognosis. COPD exacerbation has been recognized as a physical trigger for TTS, but its prognostic implications for secondary TTS are poorly understood. OBJECTIVES: The purpose of this study was to examine the effects of COPD on in-hospital outcomes in TTS patients. METHODS: Using data from the National Inpatient Sample, patients with a primary diagnosis of COPD and a secondary diagnosis of TTS were identified (COPD-TTS group). Patients with a primary diagnosis of TTS and comorbid COPD were selected as a control group (TTS-COPD group). Then, we compared the in-hospital mortality and the incidence of adverse events before and after propensity score matching. RESULTS: 603 patients were included in each of the TTS-COPD and COPD-TTS groups after matching. In both groups, the average age of included patients was about 68 years, and more than 85 percent of them were female. There were no statistically significant differences in the in-hospital mortality or the incident of cardiac arrest, ventricular arrhythmias, and AKI, between the two groups (All, p >
0.05). Patients with COPD-TTS had a higher rate of acute respiratory failure (ARF) (p <
0.001), a lower rate of cardiogenic shock (p = 0.001), and a longer length of hospital stay (LOS) (p <
0.001) compared to patients with TTS-COPD. CONCLUSIONS: Patients with COPD-TTS had a higher rate of ARF and a longer LOS but a lower risk of cardiogenic shock compared to patients with TTS-COPD.