Cardiogenic Shock in Takotsubo vs Acute Myocardial Infarction: Insights From the National Readmission Database 2016-2022.

BACKGROUND

Takotsubo cardiomyopathy (TC) can present with cardiogenic shock (TC-CS), but its clinical characteristics and outcomes compared with acute myocardial infarction-related cardiogenic shock (AMI-CS) remain understudied.

METHODS

We queried the Nationwide Readmissions Database (NRD) from 2016 to 2022 to identify hospitalizations with cardiogenic shock, classifying cases as TC-CS or AMI-CS. We compared demographic features, clinical characteristics, treatment strategies, and outcomes. The primary outcome was in-hospital mortality. Multivariable logistic regression was performed to identify independent predictors of mortality.

RESULTS

Among 236,831 cardiogenic shock hospitalizations, 7,942 were TC-CS and 228,889 were AMI-CS. Patients with TC-CS were younger (median age 66 vs. 69 years), predominantly female (72.6% vs. 34.6%), and had fewer comorbidities. Temporary mechanical circulatory support (tMCS) use (12.8% vs 36.6%, p<0.001) and in-hospital mortality (28.7% vs. 35.4%, p<0.001) were both lower in TC-CS. However, patients with TC-CS had higher rates of stroke (7.8% vs. 4.2%, p< 0.001), major bleeding (24.3% vs. 23.2%, p=0.048), and acute kidney injury requiring dialysis (9.7% vs. 8.4%, p=0.001). Among TC-CS patients, female sex, hypertension, and anemia were associated with higher survival, whereas older age, diabetes, end-stage renal disease (ESRD), stroke, and cardiac arrest were associated with lower survival.

CONCLUSIONS

Despite lower tMCS utilization, TC-CS was associated with lower in-hospital mortality but a higher rate of non-cardiac complications. These findings underscore the need for dedicated management strategies and prospective studies in this understudied population.