Key result
Mixed cardiogenic and septic shock in Takotsubo syndrome was associated with higher odds of in-hospital mortality compared to cardiogenic shock alone (aOR 1.44; 95% CI 1.36-1.52).
Why the study?
Outcomes of Takotsubo syndrome complicated by cardiogenic shock versus mixed cardiogenic and septic shock were not known.
Does mixed cardiogenic and septic shock increase in-hospital mortality compared to cardiogenic shock alone in patients with Takotsubo syndrome?
Observational (n=17,775)
Yes
Does mixed cardiogenic and septic shock increase in-hospital mortality compared to cardiogenic shock alone in patients with Takotsubo syndrome?
In patients with Takotsubo syndrome, the presence of mixed cardiogenic and septic shock is associated with significantly higher in-hospital mortality and morbidity compared to cardiogenic shock alone.
Answers are grounded in this paper and cite their sources.
May inform prognosis in TTS with shock but should not guide care; leaves open need for prospective studies on mixed vs cardiogenic shock.
INTRODUCTION: Takotsubo syndrome (TTS), also known as stress-induced cardiomyopathy, can be complicated by shock. The outcomes of patients with TTS complicated with cardiogenic shock (CS) versus mixed cardiogenic and septic shock (MS) is not known. METHODS: We queried Nationwide Inpatient Sample (NIS) from 2009-2020 to compare TTS patients with CS and MS using International Classification of Disease, Ninth & Tenth Edition, Clinical Modification (ICD- 9 & 10-CM) coding. In-hospital outcomes were compared using one: one propensity score matched (PSM) analysis. The primary outcome was in-hospital mortality. On adjusted multivariate analysis, MS patients had higher odds of in-hospital mortality (aOR 1.44, 95% CI 1.36-1.52), AKI (aOR 1.53, 95% CI 1.48-1.58), pressor requirement (aOR 1.37, 95% CI 1.25-1.50). However, had lower odds of MCS use (aOR 0.44, 95% CI 0.40-0.48) and cardiac arrest (aOR: 0.81, 95% CI 0.73-0.90) (p-value <0.0001). Mean LOS and inflation-adjusted hospital charges were higher in MS. CONCLUSION: MS in the setting of TTS have higher rates of in-hospital mortality, AKI, and pressor requirements.
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Fakhra et al. (2023) conducted an observational in Takotsubo syndrome complicated by cardiogenic or mixed cardiogenic and septic shock (n=17,775). Mixed cardiogenic and septic shock vs. Cardiogenic shock alone was evaluated on in-hospital mortality (aOR 1.44, 95% CI 1.36-1.52). Mixed cardiogenic and septic shock in Takotsubo syndrome was associated with higher odds of in-hospital mortality compared to cardiogenic shock alone (aOR 1.44; 95% CI 1.36-1.52).
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