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Background Data on outcomes of patients complicating with Takotsubo syndrome (TTS) following stroke, contributing factors and prognosis significance have not been well characterised.Objective To assess the incidence, factors and prognosis of TTS-complicated stroke, and to determine the 30-day unplanned readmission rates with TTS and its prognosis among stroke survivors without initial TTS.Methods The US Nationwide Readmission Database was queried using International Classification of Disease codes to gather information on individuals hospitalised with primary diagnosis of stroke between January 2010 and November 2021. Incidence, factors and prognosis associated with TTS-complicated stroke and 30-day unplanned readmissions with new TTS were assessed. The primary outcome was the occurrence of death during index admission for stroke as well as during readmission episode with TTS. Incidence, factors and prognosis associated with TTS-complicated stroke and 30-day unplanned readmissions with new TTS were assessed.Results Of 3 376 606 patients admitted with primary diagnosis of stroke, 6119 (0.18%) developed TTS secondary to stroke. Patients with TTS were more likely to be women (79% vs 50%, p<0.001), younger (median 67 vs 70 years), present with haemorrhagic (as opposed to ischaemic stroke, p<0.001) and have a higher comorbidity burden. The mortality rate was significantly higher in those who had TTS-complicated stroke (21% vs 7.8%, p<0.001). Of patients who were discharged without having TTS during the index admission, 217 745 (6.5%) patients had 30-day unplanned readmission, among these, 214 (0.1%) were readmitted with the new diagnosis of TTS. Patients who were readmitted with TTS were more likely to be women (79% vs 50%), had higher comorbidity burden and experienced higher mortality rate during readmission compared with those without TTS (13% vs 6.5%, p=0.008).Conclusion Although rare, TTS secondary to stroke is highly fatal. Female sex, presentation with haemorrhagic stroke and pre-existing health conditions were strong factors associated with TTS-complicated stroke. Early recognition and management of TTS-complicated stroke are of paramount importance to prevent serious consequences.