Mechanical circulatory support for cardiogenic shock in takotsubo syndrome.
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Cammann Victoria L, Schweiger Victor, Szawan Konrad A, Di Vece Davide, Niederseer David, Würdinger Michael, Schönberger Alexander, Schönberger Maximilian, Koleva Iva, Mercier Julien C, Citro Rodolfo, Vecchione Carmine, Bossone Eduardo, Gili Sebastiano, Neuhaus Michael, Franke Jennifer, Meder Benjamin, Jaguszewski Miłosz, Noutsias Michel, Knorr Maike, Jansen Thomas, D'Ascenzo Fabrizio, Dichtl Wolfgang, von Lewinski Dirk, Burgdorf Christof, Kherad Behrouz, Elsanhoury Ahmed, Tschöpe Carsten, Nelki Vivian Alice, Sarcon Annahita, Shinbane Jerold, Rajan Lawrence, Michels Guido, Pfister Roman, Cuneo Alessandro, Jacobshagen Claudius, Karakas Mahir, Koenig Wolfgang, Pott Alexander, Meyer Philippe, Roffi Marco, Banning Adrian, Wolfrum Mathias, Cuculi Florim, Kobza Richard, Fischer Thomas A, Vasankari Tuija, Airaksinen K E Juhani, Napp L Christian, Dworakowski Rafal, MacCarthy Philip, Kaiser Christoph, Osswald Stefan, Galiuto Leonarda, Chan Christina, Bridgman Paul, Beug Daniel, Felix Stephan B, Delmas Clément, Lairez Olivier, Gilyarova Ekaterina, Shilova Alexandra, Gilyarov Mikhail, El-Battrawy Ibrahim, Akin Ibrahim, Poledniková Karolina, Toušek Petr, Winchester David E, Massoomi Michael, Galuszka Jan, Ukena Christian, Poglajen Gregor, Carrilho-Ferreira Pedro, Hauck Christian, Paolini Carla, Bilato Claudio, Kobayashi Yoshio, Kato Ken, Ishibashi Iwao, Himi Toshiharu, Din Jehangir, Al-Shammari Ali, Prasad Abhiram, Rihal Charanjit S, Liu Kan, Schulze P Christian, Bianco Matteo, Jörg Lucas, Rickli Hans, Pestana Gonçalo, Nguyen Thanh H, Böhm Michael, Maier Lars S, Pinto Fausto J, Widimský Petr, Braun-Dullaeus Ruediger C, Rottbauer Wolfgang, Hasenfuß Gerd, Pieske Burkert M, Schunkert Heribert, Budnik Monika, Opolski Grzegorz, Thiele Holger, Bauersachs Johann, Horowitz John D, Di Mario Carlo, Kong William, Dalakoti Mayank, Imori Yoichi, Wehling Laura, Mangner Norman, Gerk Ulrich, Münzel Thomas, Crea Filippo, Lüscher Thomas F, Bax Jeroen J, Seifert Burkhardt, Ghadri Jelena R, Templin Christian
Аннотация
METHODS: We assessed outcomes in TTS patients with cardiogenic shock who received MCS compared to medical therapy only by using data from the International Takotsubo Registry. Two independent propensity scores were computed to investigate outcomes of patients with an intra-aortic balloon pump (IABP) vs. medical therapy only (1:2 propensity score matched cohort) and patients with an Impella vs. medical therapy only (1:1 propensity score matched cohort). The primary endpoint was in-hospital mortality and the secondary outcomes included MCS-related complications.
RESULTS: Among 3740 eligible patients, 309 (8.3%) patients had cardiogenic shock, of whom 112 (36.2%) had MCS and 197 (63.8%) had medical therapy only. After propensity-score matching, the use of an IABP was found to be associated with a lower in-hospital mortality rate than medical therapy only (14.5% vs. 35.5%, P = 0.002), while mortality rates in the Impella group and medical therapy only group were comparable (25.0% vs. 29.2%, P = 0.75). MCS-related complications occurred in 6.0% of the IABP cohort and in 31.3% of Impella cohort.
CONCLUSION: Active MCS has been increasingly used for the management of cardiogenic shock in patients with TTS. This observational study could not demonstrate an association with improved mortality with an Impella device, but possibly with an IABP when compared to patients with medical management only. MCS-related complications occurred more frequently in the Impella cohort than in the IABP cohort. Further data are required to confirm results of the present study.