Cardiogenic Shock in Takotsubo Cardiomyopathy Versus Acute Myocardial Infarction: An 8-Year National Perspective on Clinical Characteristics, Management, and Outcomes

Saraschandra Vallabhajosyula, Shannon M Dunlay, Dennis H. Murphree, Gregory W. Barsness, Gurpreet S Sandhu, Amir Lerman, Abhiram Prasad

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)469-476
Number of pages8
JournalJACC: Heart Failure
Volume7
Issue number6
DOIs
StatePublished - Jun 1 2019

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Takotsubo Cardiomyopathy
Cardiogenic Shock
Myocardial Infarction
Cardiomyopathies
Hospital Mortality
Odds Ratio
Confidence Intervals
Hospital Costs
Patient Admission

Keywords

  • acute myocardial infarction
  • apical ballooning syndrome
  • cardiogenic shock
  • National Inpatient Sample
  • outcomes research
  • stress cardiomyopathy
  • Takotsubo cardiomyopathy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Cardiogenic Shock in Takotsubo Cardiomyopathy Versus Acute Myocardial Infarction : An 8-Year National Perspective on Clinical Characteristics, Management, and Outcomes. / Vallabhajosyula, Saraschandra; Dunlay, Shannon M; Murphree, Dennis H.; Barsness, Gregory W.; Sandhu, Gurpreet S; Lerman, Amir; Prasad, Abhiram.

In: JACC: Heart Failure, Vol. 7, No. 6, 01.06.2019, p. 469-476.

Research output: Contribution to journalArticle

Vallabhajosyula, Saraschandra ; Dunlay, Shannon M ; Murphree, Dennis H. ; Barsness, Gregory W. ; Sandhu, Gurpreet S ; Lerman, Amir ; Prasad, Abhiram. / Cardiogenic Shock in Takotsubo Cardiomyopathy Versus Acute Myocardial Infarction : An 8-Year National Perspective on Clinical Characteristics, Management, and Outcomes. In: JACC: Heart Failure. 2019 ; Vol. 7, No. 6. pp. 469-476.
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abstract = "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.",
keywords = "acute myocardial infarction, apical ballooning syndrome, cardiogenic shock, National Inpatient Sample, outcomes research, stress cardiomyopathy, Takotsubo cardiomyopathy",
author = "Saraschandra Vallabhajosyula and Dunlay, {Shannon M} and Murphree, {Dennis H.} and Barsness, {Gregory W.} and Sandhu, {Gurpreet S} and Amir Lerman and Abhiram Prasad",
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T1 - Cardiogenic Shock in Takotsubo Cardiomyopathy Versus Acute Myocardial Infarction

T2 - An 8-Year National Perspective on Clinical Characteristics, Management, and Outcomes

AU - Vallabhajosyula, Saraschandra

AU - Dunlay, Shannon M

AU - Murphree, Dennis H.

AU - Barsness, Gregory W.

AU - Sandhu, Gurpreet S

AU - Lerman, Amir

AU - Prasad, Abhiram

PY - 2019/6/1

Y1 - 2019/6/1

N2 - 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.

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KW - acute myocardial infarction

KW - apical ballooning syndrome

KW - cardiogenic shock

KW - National Inpatient Sample

KW - outcomes research

KW - stress cardiomyopathy

KW - Takotsubo cardiomyopathy

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