Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, 1526 North Edgemont St, Floor 2, Los Angeles, CA 90027 USA.
J Invasive Cardiol. 2022 Apr;34(4):E274-E280. doi: 10.25270/jic/21.00086. Epub 2022 Mar 10.
This study's purpose is to evaluate the incidence, predictors, and outcomes of patients presenting to the cardiac catheterization laboratory with takotsubo syndrome complicated by respiratory failure or shock.
The presentation of takotsubo syndrome mimics acute myocardial infarction. It is often diagnosed in the cardiac catheterization laboratory when no coronary obstruction is found. A subset of these patients develops shock or respiratory failure.
This is a retrospective study of patients who underwent cardiac catheterization at the Kaiser Permanente Southern California health system with takotsubo syndrome between 2006 to 2016. Medical records were manually reviewed to identify patient characteristics, treatment, and clinical outcomes.
Among 530 patients with takotsubo syndrome, 56 (10.6%) developed shock or respiratory failure and required mechanical or inotropic support. A higher proportion of these patients were men (14.3% vs 5.7%) and Black (10.7% vs 7.0%). In multivariate logistic regression analyses, factors associated with respiratory failure or shock were age (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.94-0.99; P=.02), chronic obstructive pulmonary disease (OR, 1.9; 95% CI, 1.1-3.5; P=.02), chronic kidney disease (OR, 2.6; 95% CI, 1.3-5.3; P=.01), physical trigger (OR, 5.7; 95% CI, 3.0-10.8; P<.01), and ST elevation on the presenting electrocardiogram (OR, 2.5; 95% CI, 1.4-4.8; P=.04). Patients who required mechanical ventilation or inotropic support had significantly higher mortality (hazard ratio, 3.9; 95% CI, 2.1-7.1; P<.001).
Shock or respiratory failure occur in 10.6% of patients presenting with takotsubo syndrome. Men and patients with baseline respiratory or renal disease were disproportionally affected. These patients have significantly worse clinical outcomes.
本研究旨在评估因 Takotsubo 综合征导致呼吸衰竭或休克而就诊于心导管实验室的患者的发病率、预测因素和结局。
Takotsubo 综合征的表现类似于急性心肌梗死。当未发现冠状动脉阻塞时，它通常在心导管实验室中诊断出来。这些患者中有一部分会出现休克或呼吸衰竭。
这是一项对 2006 年至 2016 年期间在 Kaiser Permanente 南加州医疗系统接受心导管检查且患有 Takotsubo 综合征的患者进行的回顾性研究。通过手动审查病历来确定患者特征、治疗和临床结局。
在 530 例 Takotsubo 综合征患者中，有 56 例（10.6%）发生休克或呼吸衰竭，需要机械通气或正性肌力支持。这些患者中男性（14.3% vs. 5.7%）和黑人（10.7% vs. 7.0%）的比例较高。多变量逻辑回归分析显示，与呼吸衰竭或休克相关的因素是年龄（比值比[OR]，0.97；95%置信区间[CI]，0.94-0.99；P=.02）、慢性阻塞性肺疾病（OR，1.9；95%CI，1.1-3.5；P=.02）、慢性肾脏病（OR，2.6；95%CI，1.3-5.3；P=.01）、物理触发（OR，5.7；95%CI，3.0-10.8；P<.01）和就诊时心电图上的 ST 段抬高（OR，2.5；95%CI，1.4-4.8；P=.04）。需要机械通气或正性肌力支持的患者死亡率显著更高（风险比[HR]，3.9；95%CI，2.1-7.1；P<.001）。
因 Takotsubo 综合征就诊的患者中，有 10.6%出现休克或呼吸衰竭。男性和基线存在呼吸或肾脏疾病的患者受影响不成比例。这些患者的临床结局明显更差。
