Division of Cardiology, West Virginia University, Morgantown, West Virginia.
Department of Medicine, West Virginia University, Morgantown, West Virginia.
Am J Cardiol. 2020 Dec 1;136:24-31. doi: 10.1016/j.amjcard.2020.09.014. Epub 2020 Sep 15.
There is limited data on the in-hospital outcomes of cardiogenic shock (CS) secondary to takotsubo syndrome (TS). We aimed to assess the incidence, predictors, and outcomes of CS in hospitalized patients with TS. All patients with TS were identified from the National Inpatient Sample database from September 2006 to December 2017. The cohort was divided into those with versus without CS and logistic regression analysis was used to identify predictors of CS and mortality in patients admitted with TS. A total of 260,144 patients with TS were included in our study, of whom 14,703 (6%) were diagnosed with CS. In-hospital mortality in patients with CS was approximately six-fold higher compared with those without CS (23% vs 4%, p <0.01). TS patients with CS had a higher incidence of malignant arrhythmias like ventricular tachycardia or ventricular fibrillation (15.0% vs 4%, p <0.01) and non-shockable cardiac arrests (12% vs 2%, p <0.01). Independent predictors of CS were male gender, Asian and Hispanic ethnicity, increased burden of co-morbidities including congestive heart failure, chronic pulmonary disease, and chronic diabetes. Independent predictors of mortality were male gender, advanced age, history of congestive heart failure, chronic renal failure, and chronic liver disease. In conclusion, CS occurs in approximately 6% of patients admitted with TS, in-hospital mortality in TS patients with CS was approximately six-fold higher compared with those without CS (23% vs 4%, p <0.01), male gender and increased burden of co-morbidities at baseline were independent predictors of CS and mortality.
患有心尖球囊样综合征（TS）的患者并发心原性休克（CS）的院内预后数据有限。我们旨在评估住院 TS 患者 CS 的发生率、预测因素和结局。所有 TS 患者均从 2006 年 9 月至 2017 年 12 月的国家住院患者样本数据库中确定。该队列分为伴有 CS 和不伴有 CS 的患者，并使用 logistic 回归分析确定了患有 TS 患者 CS 的预测因素和死亡率。共有 260,144 例 TS 患者纳入我们的研究，其中 14,703 例（6%）被诊断为 CS。伴有 CS 的 TS 患者的院内死亡率比不伴有 CS 的患者高近六倍（23%比 4%，p<0.01）。CS 患者中恶性心律失常（如室性心动过速或心室颤动）和非电击性心脏骤停的发生率更高（15.0%比 4%，p<0.01）。CS 的独立预测因素为男性、亚洲和西班牙裔种族、合并症负担增加，包括充血性心力衰竭、慢性肺部疾病和慢性糖尿病。死亡率的独立预测因素为男性、高龄、充血性心力衰竭、慢性肾衰竭和慢性肝病的病史。总之，CS 发生在大约 6%住院治疗的 TS 患者中，患有 CS 的 TS 患者的院内死亡率比不伴有 CS 的患者高近六倍（23%比 4%，p<0.01），男性性别和基线时合并症负担增加是 CS 和死亡率的独立预测因素。
