Clinical Characteristics and Outcomes of Cardiogenic Shock in Acute Myocarditis Versus Takotsubo Cardiomyopathy: A Propensity Matched Nationwide Analysis.

BACKGROUND

Cardiogenic shock (CS) is a life-threatening complication of acute myocarditis (MC) and takotsubo cardiomyopathy (TC). Comparative data on mechanical circulatory support (MCS) utilization and outcomes between these cohorts remain undefined.

METHODS

Using the National Inpatient Sample 2020-2022 database, adult hospitalizations with concomitant diagnoses of CS and MC (MC-CS) or TC (TC-CS) were identified. Patients with cardiac arrest, acute coronary syndrome, coronary revascularization, or incomplete records were excluded. A 1:1 propensity score match was performed to balance demographics, baseline comorbidities, and hospital characteristics. The primary outcome was in-hospital mortality. Secondary outcomes included MCS and resource utilization.

RESULTS

Among 7080 hospitalizations (MC-CS: n = 2825; TC-CS: n = 4255), patients with MC-CS were younger (46.5 vs 62.9 years) and predominantly male (58.0% vs 27.5%). Propensity score matching yielded 2435 balanced pairs. In the matched cohort, hospital mortality (26.5% vs 26.7%; P = .97) and length of stay (16.2 vs 16.0 days; P = .96) were comparable between groups. MC-CS was associated with higher use of temporary MCS (30.0% vs 10.5%; P < .001), including extracorporeal membrane oxygenation (14.2% vs 2.3%, P = .003), Impella (14.6% vs 6.8%, P = .04), and intra-aortic balloon pump (13.6% vs 3.1%, P = .003). Total hospital charges were higher for MC-CS ($435,121 vs $288,522; P = .008).

CONCLUSIONS

In patients with CS, hospital mortality and length of stay are comparable between MC-CS and TC-CS when matched for baseline clinical risk. However, MC-CS involves nearly 3-fold higher utilization of MCS alongside higher hospital charges.