Post-discharge prognosis of stress cardiomyopathy in women: a retrospective cohort study

There is limited information on the prognosis of stress cardiomyopathy (SCM) after hospital discharge. The aim of this retrospective cohort study was to determine the post-discharge prognosis of women with SCM compared to female controls with ST-segment elevation myocardial infarction (STEMI). SCM cases were identified through chart reviews of women hospitalized at a single tertiary care medical center between 2002 and 2012. Controls were randomly selected (2:1 ratio) among women admitted with a validated diagnosis of STEMI during the same period. The primary outcome was a composite of cardiovascular readmissions and death from any cause. Risk of the composite outcome was estimated from multivariate Cox proportional hazard regression models. Over an average follow-up of 24 months, incidence rates of the composite outcome were 140/1000 person-years among cases (n = 50) and 347/1000 person-years among controls (n = 100; P < 0.001). SCM women had a lower unadjusted risk of cardiovascular readmissions and death vs. STEMI women (HR: 0.47; 95% CI: 0.27, 0.82). This difference in risk was reduced after adjustment for demographic and clinical confounders (HR: 0.64; 95% CI: 0.30, 1.33). The lower risk of developing the composite outcome among SCM women was driven by a lower risk of death, while the risk of cardiovascular readmissions was similar between groups. Risk of death and cardiovascular readmissions post-discharge was lower among women with SCM than among women with STEMI. Incidence rates of cardiovascular readmissions, however, were similar, indicating that SCM may not be a benign condition.