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

Document Type

Article

Publication Date

12-1-2025

Publication Title

The Canadian journal of cardiology

Keywords

Humans, Shock, Cardiogenic, Female, Male, Aged, Takotsubo Cardiomyopathy, Myocardial Infarction, Hospital Mortality, Databases, Factual, United States, Middle Aged, Patient Readmission, Retrospective Studies, Risk Factors

Abstract

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.

Medical Subject Headings

Humans; Shock, Cardiogenic; Female; Male; Aged; Takotsubo Cardiomyopathy; Myocardial Infarction; Hospital Mortality; Databases, Factual; United States; Middle Aged; Patient Readmission; Retrospective Studies; Risk Factors

PubMed ID

41109669

Volume

41

Issue

12

First Page

2431

Last Page

2439

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