Abstract 15415: Trends and Predictors of Cardiogenic Shock and Mortality in Takotsubo Syndrome

Abstract

Introduction: There is limited data on trends, predictors and outcomes of cardiogenic shock (CS) and mortality among patients admitted with takotsubo syndrome (TTS). We aim to study these parameters from the national inpatient sample. Methods: We analyzed the National Inpatient Sample (NIS) database from September 2006 to December 2017 to assess the trends and predictors of cardiogenic shock and mortality among patients with TTS. Results: A total of total of 265,423 patients with takotsubo syndrome (TTS) were included in our study, of whom 14703 (5.5%) were diagnosed with cardiogenic shock (CS). TTS Patients with CS were more likely to be younger (67, Interquartile range [IQR] 57-75 vs 68, 58-78), males (20.9% vs 13.8%, P <0.01), with key ethnicities being Asian and Hispanic. TTS patients with CS were also more likely to have multiple medical comorbidities at baseline including congestive heart failure (65.7% vs 40.9%, P <0.01), chronic lung disease (31.1% vs 29.2%, P <0.01) diabetes with chronic complications (7.4% vs 5.6%, P <0.01) and chronic kidney disease (13.2% vs 11.1% P <0.01). TTS patients with CS had a higher incidence of malignant arrhythmias including ventricular tachycardia or ventricular fibrillation (15.0% vs 4.6%, P <0.01) and non-shockable cardiac arrests (12.2% vs 2.3%, P <0.01). In-hospital mortality among patients with TTS-CS was fivefold higher compared to those without CS (22.9% vs 4%, P <0.01). During our study period we also noted a significant increase in trends of cardiogenic shock and mortality among patients with TTS. Conclusions: In hospital mortality among TTS patients with CS was approximately five-fold higher compared to those without CS (22.9% vs 4.0%, P <0.01).Future research should be directed towards management strategies to improve outcomes in patients with TTS.