Background: Current data suggest an excellent outcome for patients with Tako-tsubo cardiomyopathy (TC). The objectives of this study were to evaluate the long-term outcome and the prognostic implication of thrombolysis in myocardial infarction myocardial perfusion grade (TMPG) in patients with TC. Methods: Retrospective analysis of all patients diagnosed with TC at our hospital between 2003 and 2008. Results: During the five-year period, we identified 27 patients with TC out of 1374 cases of emergent left heart catheterisation (2%). Mean follow-up was 27 +/- 16 months. The majority were Caucasian (81%) female (96%), postmenopausal (96%), with a mean age of 68 +/- 14 years. A precipitating stressor event was found in 74% of the patients, 30% being gastrointestinal triggers. Fourteen patients (52%) reached a combined end point of all cause death, cardiogenic shock, sudden cardiac death and rehospitalisation for cardiac reasons. TMPG was abnormal in 37% cases with no correlation with the outcome. Conclusions: The long-term outcome of patients with TC is worse than previously reported. TMPG does not correlate with the outcome in TC. (Heart, Lung and Circulation 2010;19:601-605) (C) 2010 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. Published by Elsevier Inc. All rights reserved.