Trends and cardiovascular outcomes of Takotsubo syndrome with cardiogenic shock vs. mixed cardiogenic and septic shock: a nationwide propensity matched analysis

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.

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.

Of 23,126 patients with TTS 17,132 (74%) had CS, and 6,269 (26%) had MS. The mean age was 67 years in CS and 66 years in MS, and majority of patients were female (n = 17,775, 77%). 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.

MS in the setting of TTS have higher rates of in-hospital mortality, AKI, and pressor requirements.