First Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
First Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; DZHK, Partner Site, Heidelberg-Mannheim, Mannheim, Germany.
Can J Cardiol. 2020 Jun;36(6):860-867. doi: 10.1016/j.cjca.2019.10.012. Epub 2019 Oct 16.
Cardiogenic shock (CS) is a severe complication of myocardial infarction (MI) or of takotsubo syndrome (TTS). For both diseases, CS is related to a worse long-term outcome. The outcome of CS has not been studied in a direct comparison of patients with MI and patients with TTS.
Mortality and cardiovascular complications were compared in patients presenting with CS based on MI or TTS between 2003 and 2017 during a follow-up of 5 years. A total of 138 patients with TTS and 532 patients with MI were included. Of these, 66 patients with MI and 25 patients with TTS developed CS (12% vs 18%, P = 0.08).
Patients with MI and CS had more often malignant arrhythmias (74% vs 28%, P < 0.01), and need for resuscitation (80% vs 24%, P < 0.01) or death (71% vs 24%, P < 0.01) than patients with TTS and CS during the first 30 days. Although the overall rate of death remained higher in MI than in TTS (75.8% vs 52%, log rank, P < 0.01), deaths occurred in TTS constantly throughout the follow-up time, but not in MI. The incidence of heart failure increased in MI but not in TTS (31.8% vs 4%, P < 0.01) during follow-up.
Patients with MI and CS have a worse prognosis than patients with TTS and CS. This is driven by cardiovascular events or death during the first 30 days after the index event. However, patients with TTS and CS show high mortality as well, especially during long-term follow-up.
心原性休克（CS）是心肌梗死（MI）或心尖球囊样综合征（TTS）的严重并发症。对于这两种疾病，CS 与较差的长期预后相关。MI 患者和 TTS 患者 CS 的预后尚未在直接比较中进行研究。
在 2003 年至 2017 年的 5 年随访期间，根据 MI 或 TTS 比较 CS 患者的死亡率和心血管并发症。共纳入 138 例 TTS 患者和 532 例 MI 患者。其中，66 例 MI 患者和 25 例 TTS 患者发展为 CS（12%比 18%，P=0.08）。
MI 合并 CS 的患者更常出现恶性心律失常（74%比 28%，P<0.01），需要复苏（80%比 24%，P<0.01）或死亡（71%比 24%，P<0.01），而 TTS 合并 CS 的患者在前 30 天。尽管 MI 的总死亡率仍高于 TTS（75.8%比 52%，对数秩检验，P<0.01），但 TTS 患者的死亡持续整个随访时间，而 MI 患者则没有。MI 患者心力衰竭的发生率增加（31.8%比 4%，P<0.01），而 TTS 患者则没有。
MI 合并 CS 的患者预后较 TTS 合并 CS 的患者差。这是由指数事件后 30 天内的心血管事件或死亡引起的。然而，TTS 合并 CS 的患者也有很高的死亡率，尤其是在长期随访中。
