The use of an intra-aortic balloon pump reduced in-hospital mortality to 14.5% compared to 35.5% in the medical therapy only group in patients with takotsubo syndrome and cardiogenic shock.
Observational (n=309)
Sí
Does mechanical circulatory support (IABP or Impella) reduce in-hospital mortality in patients with takotsubo syndrome complicated by cardiogenic shock compared to medical therapy alone?
In patients with takotsubo syndrome and cardiogenic shock, IABP use was associated with lower in-hospital mortality compared to medical therapy alone, whereas Impella use was not associated with improved survival and had higher complication rates.
Estimación del efecto: OR 0.35 (95% CI 0.21-0.59)
Tasa de eventos absoluta: 14.5% vs 35.5%
valor p: p=0.002
Abstract Background Cardiogenic shock complicates takotsubo syndrome (TTS) in approximately 10% of cases. The effectiveness of mechanical circulatory support (MCS) for managing cardiogenic shock in TTS remains unknown. 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. Graphical Abstract
Cammann et al. (Mon,) conducted a observational in Takotsubo syndrome complicated by cardiogenic shock (n=309). Intra-aortic balloon pump (IABP) / Impella vs. Medical therapy only was evaluated on In-hospital mortality rate (OR 0.35, 95% CI 0.21-0.59, p=0.002). The use of an intra-aortic balloon pump reduced in-hospital mortality to 14.5% compared to 35.5% in the medical therapy only group in patients with takotsubo syndrome and cardiogenic shock.