D-3 | Trends in Mortality and Use of Temporary Mechanical Circulatory Support Modalities for Takotsubo Cardiomyopathy Associated Refractory Cardiogenic Shock

The use of Mechanical Circulatory Support (MCS) devices in cardiogenic shock is growing; however, their use in Takotsubo cardiomyopathy-associated cardiogenic shock (TTS-CS) is under-studied The national readmission database (2016-2020) was used to identify patients with TTS-CS requiring MCS. Mahalanobis Distance Matching was utilized for propensity matching. Pearson's x2 test was applied to the matched cohorts to compare outcomes. We used multivariate regression and reported predictive margins for adjusted trend analysis. Among 2,025 TTC-CS hospitalizations requiring MCS, 1,790 received pLVAD (Impella/TendemHeart) vs 235 receiving ECMO. After propensity matching (N 95 in each cohort) ECMO cohort had higher median LOS (17 vs. 9 days) & total cost ($169,555 vs. $54,190) [p<0.001] but a lower readmission rate at 90-day (8% vs. 16.2%, p: 0.009) & 180-day interval (13.8% vs. 23%, p: 0.026). From 2016-2020, median LOS remained the same for both pLVAD and ECMO groups (p-trend>0.05). However, the total cost increased in hospitalization requiring pLVAD ($43,159 to $63,570, p-trend <0.001). IABP use in TTS-CS has decreased from 2016-2020 (13.6 % to 7.4 %, p-trend: <0.01). Similarly rates of angiography in these showed a decreasing trend (50% to 42.9%, p-trend 0.023). However, the use of ECMO (13.5% to 24.5%, p-trend: 0.041) and pLVADs (29% to 59.3%, p-trend 0.034) have increased over the years. The adjusted mortality rates associated with TTC-CS have not significantly changed over the years (p-trend). In TTS-CS, the ECMO cohort had higher LOS and total cost at index admission but lower readmission rates up to six months follow up. The use of ECMO and pLVADs is increasing, while IABP is decreasing for mechanical circulatory support in TTS. TTS-CS continued to be associated with a higher mortality rate, which did not change over the study period.