Author + information
- Received October 10, 2018
- Revision received November 29, 2018
- Accepted December 9, 2018
- Published online May 8, 2019.
- Saraschandra Vallabhajosyula, MBBSa,
- Shannon M. Dunlay, MD, MSa,b,
- Dennis H. Murphree Jr., PhDb,
- Gregory W. Barsness, MDa,
- Gurpreet S. Sandhu, MD, PhDa,
- Amir Lerman, MDa and
- Abhiram Prasad, MDa,∗ ()
- aDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
- bDepartment of Health Science Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
- ↵∗Address for correspondence:
Dr. Abhiram Prasad, Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905.
Objectives This study sought to evaluate the clinical characteristics and outcomes of Takotusbo cardiomyopathy cardiogenic shock (TC-CS) in comparison to those of acute myocardial infarction cardiogenic shock (AMI-CS) among patients hospitalized in the United States. We additionally sought to compare the incidence of multiorgan failure and use of supportive therapies as well as the trends over time, given the increasing awareness and diagnosis of TC.
Background CS is a major complication of TC; however, there are limited data, especially as to how TC-CS compares to AMI-CS.
Methods The National Inpatient Sample Database was used to identify adults hospitalized with CS in the setting of TC and AMI from 2007 to 2014. We required patients admitted with TC to have undergone coronary angiography without intervention. Clinical characteristics and in-hospital outcomes in TC-CS patients were compared with those in AMI-CS patients. Multivariate regression and propensity matching were used to adjust for potential confounding factors.
Results Between 2007 and 2014, there were 374,152 admissions for CS due to either TC or AMI, of which 4,614 patients (1.2%) had TC-CS. TC-CS admission patients were more likely to be younger, white females with fewer comorbidities. Rates of respiratory failure and mechanical ventilation were higher in TC-CS, but cardiac arrest and acute kidney injury were lower. There were no differences between cohorts in use of intra-aortic balloon pumps. TC-CS admissions had lower in-hospital mortality (15% vs. 37%, respectively) and hospital costs (U.S. dollars: $135,397 ± $127,617 vs. $154,827 ± $186,035, respectively) and were discharged home more often (45% vs. 36%, respectively) compared to AMI-CS admissions (all: p < 0.001). After adjustments for potential confounders, TC-CS was associated with lower in-hospital mortality (odds ratio [OR]: 0.35; 95% confidence interval [CI]: 0.32 to 0.38; p < 0.001). Similar findings were observed in the propensity-matched cohort (OR: 0.32; 95% CI: 0.25 to 0.39; p < 0.001).
Conclusions There are key differences between the clinical characteristics and multiorgan failure patterns in TC-CS compared to those in AMI-CS. In-hospital mortality (15%) is lower in TC-CS.
- acute myocardial infarction
- apical ballooning syndrome
- cardiogenic shock
- National Inpatient Sample
- outcomes research
- stress cardiomyopathy
- Takotsubo cardiomyopathy
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 10, 2018.
- Revision received November 29, 2018.
- Accepted December 9, 2018.
- 2019 American College of Cardiology Foundation
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