Prognostic implications of takotsubo cardiomyopathy in cardiogenic shock: A propensity score-matched analysis of the national inpatient sample (2016-2020)

Abstract

Background: Takotsubo cardiomyopathy (TTC), also called stress-induced cardiomyopathy, characterized by transient acute systolic dysfunction mimicking myocardial infarction in the absence of obstructive coronary artery disease, is a recognized cause of cardiogenic shock.

Objectives: This study aimed to investigate whether TTC is associated with favorable in-hospital outcomes in patients admitted for cardiogenic shock.

Methods: We used National Inpatient Sample (2016-2020) data to identify admissions with cardiogenic shock and Takotsubo syndrome (TTC) using ICD-10 codes. A 1:1 nearest-neighbor propensity score matching was performed with sociodemographic and clinical variables as matching factors. All-cause in-hospital mortality was the primary outcome, and secondary outcomes included in-hospital complications, length of stay (LOS), and total cost of hospitalization.

Results: The final sample included 22,594 admissions, evenly distributed between the groups with and without TTC. The cohort's mean age was 65.4 years (SD = 15.9), with 74.7 % being males. The overall in-hospital mortality rate was 32.7 %. The TTC group had a lower overall in-hospital mortality rate (OR = 0.60; 95 % CI [0.56, 0.63]) and 30-day in-hospital mortality rate (HR = 0.61; 95 % CI [0.59, 0.64]). Admissions with TTC had lower odds of in-hospital complications, including cardiac arrest, ventricular arrhythmia, and acute kidney injury. However, they were noted to have higher odds of deep vein thrombosis, ischemic stroke, intracranial hemorrhage, and a marginally higher LOS, and total cost of hospitalizations.

Conclusion: Our study suggests that TTC is associated with significantly lower in-hospital mortality rates among cardiogenic shock admissions.

Keywords: Cardiogenic shock; Mortality; National inpatient sample; Prognosis; Takotsubo.