Short- and Long-Term Prognostic Relevance of Cardiogenic Shock in Takotsubo Syndrome Results From the RETAKO Registry

OBJECTIVES This study sought to describe the incidence, determinants, and prognostic impact of cardiogenic shock (CS) in takotsubo syndrome (TTS). BACKGROUND TTS can be associated with severe hemodynamic instability. The prognostic implication of CS has not been well characterized in large studies o...

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Detalles Bibliográficos
Autores: Almendro-Delia, M, Nunez-Gil, IJ, Lobo, M, Andres, M, Vedia, O, Sionis, A, Martin-Garcia, A, Aguilera, MC, Pereyra, E, de Miguel, IM, Vicente, JAL, Corbi-Pascual, M, Bosch, X, Andres, OF, Flecha, ASG, Perez-Castellanos, A, Pais, JL, Martin, MD, Villa, JME, Asenjo, RM, Marzo, MG, Sobella, FR, Acena, A, Acuna, JMG, Garcia-Rubira, JC
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2018
País:España
Institución:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
Repositorio:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
OAI Identifier:oai:iibsantpau.fundanetsuite.com:p3235
Acceso en línea:https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=3235
Access Level:acceso abierto
Palabra clave:beta blockers
cardiogenic shock
stress
Takotsubo syndrome
Descripción
Sumario:OBJECTIVES This study sought to describe the incidence, determinants, and prognostic impact of cardiogenic shock (CS) in takotsubo syndrome (TTS). BACKGROUND TTS can be associated with severe hemodynamic instability. The prognostic implication of CS has not been well characterized in large studies of TTS. METHODS We analyzed patients with a definitive TTS diagnosis (modified Mayo criteria) who were recruited for the National RETAKO (Registry on Takotsubo Syndrome) trial from 2003 to 2016. Cox and competing risk regression models were used to identify factors associated with mortality and recurrences. RESULTS A total of 711 patients were included, 81 (11.4%) of whom developed CS. Mate sex, QTc interval prolongation, tower left ventricular ejection fraction at admission, physical triggers, and presence of "a significant" left intraventricular pressure gradient, were associated with CS (C index 0.85). In-hospital complication rates, including mortality, were significantly higher in patients with CS. Over a median follow-up of 284 days (interquartile range: 94 to 929 days), CS was the strongest independent predictor of tong-term, all-cause mortality (hazard ratio (HR]: 5.38; 95% confidence interval (CI): 2.60 to 8.38); cardiovascular (CV) death (sub-HR: 4.29; 95% CI: 2.40 to 21.2), and non-CV death (sub-HR: 3.34; 95% CI: 1.70 to 6.53), whereas no significant difference in the recurrence rate was observed between groups (sub-HR: 0.76; 95% CI: 0.10 to 5.95). Among patients with CS, those who received beta-blockers at hospital discharge experienced lower 1-year mortality compared with those who did not receive a beta-blocker (HR: 0.52; 95% 0: 0.44 to 0.79; p(interaction) = 0.043). CONCLUSIONS CS is not uncommon and is associated with worse short- and long-term prognosis in TTS. CS complicating TTS may constitute a marker of underlying disease severity and could identify a masked heart failure phenotype with increased vulnerability to catecholamine-mediated myocardial stunning. (C) 2018 by the American College of Cardiology Foundation.

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