Trends and cardiovascular outcomes of Takotsubo syndrome with cardiogenic shock vs. mixed cardiogenic and septic shock: a nationwide propensity matched analysis

ABSTRACT

Introduction

Takotsubo syndrome (TTS), also known as stress-induced cardiomyopathy, can be complicated by shock. The outcomes of patients with TTS complicated with cardiogenic shock (CS) versus mixed cardiogenic and septic shock (MS) is not known.

Methods

We queried Nationwide Inpatient Sample (NIS) from 2009–2020 to compare TTS patients with CS and MS using International Classification of Disease, Ninth & Tenth Edition, Clinical Modification (ICD- 9 & 10-CM) coding. In-hospital outcomes were compared using one: one propensity score matched (PSM) analysis. The primary outcome was in-hospital mortality.

Results

Of 23,126 patients with TTS 17,132 (74%) had CS, and 6,269 (26%) had MS. The mean age was 67 years in CS and 66 years in MS, and majority of patients were female (n = 17,775, 77%). On adjusted multivariate analysis, MS patients had higher odds of in-hospital mortality (aOR 1.44, 95% CI 1.36–1.52), AKI (aOR 1.53, 95% CI 1.48–1.58), pressor requirement (aOR 1.37, 95% CI 1.25–1.50). However, had lower odds of MCS use (aOR 0.44, 95% CI 0.40–0.48) and cardiac arrest (aOR: 0.81, 95% CI 0.73–0.90) (p-value <0.0001). Mean LOS and inflation-adjusted hospital charges were higher in MS.

Conclusion

MS in the setting of TTS have higher rates of in-hospital mortality, AKI, and pressor requirements.

KEYWORDS:

• Cardiogenic shock
• septic shock
• mixed shock
• takotsubo syndrome
• takotsubo cardiomyopathy

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Author contributions

S Fakhra: Conceptualization, Writing- Original draft preparation, editing, organization of tasks. M Faisaluddin: Data curation and analysis, Reviewing and Editing. Y Sattar: Conceptualization, analysis, editing, final approval. D DeCicco: Writing, Reviewing, and Editing, supplementary file. N Patel: Visual Abstract, figures, tables. A Ahmed: Methodology, Writing, supplementary file. S Erdem: Writing and editing. A Titus: Graphics, final edits. D Ludhwani: Methodology, Writing. H Masood: Analysis review, editing. S Raina: Writing, supplementary file. K Gonuguntla: Reviewing, final edits. SC Feitell: Table editing, final manuscript edits. T Tarun: Supplementary file editing. S Balla: Conceptualization, Reviewing, final edits, supervision of the project.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14779072.2023.2295378.

Additional information

Funding

This paper was not funded.