Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Department of Health Science Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.
JACC Heart Fail. 2019 Jun;7(6):469-476. doi: 10.1016/j.jchf.2018.12.007. Epub 2019 May 8.
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.
CS is a major complication of TC; however, there are limited data, especially as to how TC-CS compares to AMI-CS.
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.
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).
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.
本研究旨在评估美国住院患者中 Takotusbo 心肌病心原性休克（TC-CS）与急性心肌梗死心原性休克（AMI-CS）的临床特征和结局，并比较两种疾病的多器官衰竭发生率和支持性治疗的应用情况。鉴于 TC 的发病率和诊断率不断增加，我们还比较了这一趋势随时间的变化。
CS 是 TC 的主要并发症，但目前数据有限，特别是关于 TC-CS 与 AMI-CS 的比较。
本研究使用美国国家住院患者样本数据库（National Inpatient Sample Database），从 2007 年至 2014 年期间，识别出 TC 和 AMI 导致 CS 的成年住院患者。我们要求诊断 TC 的患者接受过冠状动脉造影但未进行介入治疗。将 TC-CS 患者的临床特征和住院结局与 AMI-CS 患者进行比较。使用多元回归和倾向匹配来调整潜在混杂因素。
2007 年至 2014 年间，CS 因 TC 或 AMI 共收治 374152 例患者，其中 4614 例（1.2%）为 TC-CS。TC-CS 入院患者更可能是年轻、白人女性，合并症较少。TC-CS 患者的呼吸衰竭和机械通气发生率较高，但心脏骤停和急性肾损伤发生率较低。两组患者使用主动脉内球囊反搏的比例无差异。TC-CS 患者的住院死亡率（分别为 15%和 37%）和住院费用（美元：分别为 135397 美元±127617 美元和 154827 美元±186035 美元）较低，出院回家的比例（分别为 45%和 36%）较高（均为 p<0.001）。在调整潜在混杂因素后，TC-CS 与住院死亡率降低相关（比值比 [OR]：0.35；95%置信区间 [CI]：0.32 至 0.38；p<0.001）。在倾向匹配队列中也观察到类似的结果（OR：0.32；95% CI：0.25 至 0.39；p<0.001）。
与 AMI-CS 相比，TC-CS 在临床特征和多器官衰竭模式方面存在关键差异。TC-CS 的住院死亡率（15%）较低。
