Log in to MyACC
Cardiogenic Shock in Takotsubo Cardiomyopathy vs. Acute MI
Study Questions:
What is the difference in cardiogenic shock (CS) outcomes between Takotsubo cardiomyopathy (TC) and acute myocardial infarction (AMI)?
Methods:
The National Inpatient Sample Database was used from 2007-2014 to identity a retrospective cohort of patients with TC and AMI associated with CS. The primary outcome was in-hospital mortality and secondary outcomes were hospital length of stay, hospital costs, and disposition at discharge. Clinical outcomes were compared between TC-CS and AMI-CS.
Results:
Between 2007-2014, 1.2% of CS patients were TC-CS. In the AMI-CS group, 55% were non–ST-segment elevation AMI and 45% were ST-segment elevation AMI. TC-CS patients were younger, had lower comorbidity, and were more likely to be white females, have private insurance, and come from higher socioeconomic status. TC-CS patients also had a lower rate of cardiac arrest (11.3% vs. 19.1%, p < 0.001) and less incidence of renal and hepatic injury compared to AMI-CS patients. Rates of acute respiratory failure were higher in patients with TC-CS (59.8% vs. 51.1%, p < 0.001). There were no differences in use of total mechanical circulatory support or intra-aortic balloon pump between the two cohorts. Although length of stay was similar in both groups, hospitalization costs were lower in TC-CS patients. In a multivariate analysis, the presence of TC-CS was an independent predictor of survival (odds ratio, 0.35; 95% confidence interval, 0.32-0.38; p < 0.001).
Conclusions:
Although TC-CS remains a rare cause of CS, the incidence has increased over time. There are differences in outcomes between TC-CS and AMI-CS; more specifically, lower in-hospital mortality.
Perspective:
When evaluating a patient for CS, it is important to recognize TC as a potential cause. TC-CS patients are managed no differently for CS in terms of supportive care and hospitalization course. Outcomes tend to favor its prognosis if patients are treated accordingly.
Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Cardiac Surgery, Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Implantable Devices, SCD/Ventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Acute Heart Failure, Mechanical Circulatory Support
Keywords: Acute Coronary Syndrome, Comorbidity, Heart Arrest, Heart Failure, Hospital Costs, Inpatients, Intra-Aortic Balloon Pumping, Length of Stay, Myocardial Infarction, Respiratory Insufficiency, Shock, Cardiogenic, Takotsubo Cardiomyopathy
< Back to Listings
