Short- and Long-Term Prognostic Relevance of Cardiogenic Shock in Takotsubo Syndrome Results From the RETAKO Registry
Por:
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 and Garcia-Rubira, JC
Publicada:
1 nov 2018
Categoría:
Cardiology and cardiovascular medicine
Resumen:
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.
Filiaciones:
Almendro-Delia, M:
Hosp Virgen Macarena, Serv Cardiol, Unidad Coronaria, Seville, Spain
Nunez-Gil, IJ:
Hosp Clin San Carlos, Inst Cardiovasc, Madrid, Spain
Lobo, M:
Hosp Virgen Macarena, Serv Cardiol, Unidad Coronaria, Seville, Spain
Andres, M:
Hosp Univ Vall dHebron, Serv Cardiol, Barcelona, Spain
Vedia, O:
Hosp Clin San Carlos, Inst Cardiovasc, Madrid, Spain
Sionis, A:
Inst Invest Biomed St Pau IIB St Pau, Unidad Cuidados Intens Cardiol, Serv Cardiol, Barcelona, Spain
Martin-Garcia, A:
Hosp Univ Salamanca IBSAL CIBERCV, Cardiol S, Salamanca, Spain
Aguilera, MC:
Hosp Princesa, Cardiol S, Madrid, Spain
Pereyra, E:
Hosp Arnau Vilanova, Cardiol S, Lerida, Spain
de Miguel, IM:
Hosp Gen Univ Gregorio Maranon, Cardiol S, Madrid, Spain
Vicente, JAL:
Hosp Clin Lozano Blesa, Cardiol S, Zaragoza, Spain
Corbi-Pascual, M:
Hosp Univ Albacete, Serv Cardiol, Albacete, Spain
Bosch, X:
Univ Barcelona, Hosp Clin, IDIBAPS, Unidad Cuidados Cardiacos Agudos,Serv Cardiol, Barcelona, Spain
Andres, OF:
Hosp Gen Univ Valencia, Serv Cardiol, Valencia, Spain
Flecha, ASG:
Hosp Univ Canarias, Serv Cardiol, Tenerife, Spain
Perez-Castellanos, A:
Hosp Manacor, Serv Cardiol, Baleares, Spain
Pais, JL:
Hosp Univ Getafe, Serv Cardiol, Madrid, Spain
Martin, MD:
Hosp Carlos Haya, Serv Cardiol, Malaga, Spain
Villa, JME:
Hosp Puerta de Hierro, Serv Cardiol, Madrid, Spain
Asenjo, RM:
Hosp 12 Octubre, Serv Cardiol, Madrid, Spain
Marzo, MG:
Hosp Joan 23, Serv Cardiol, Tarragona, Spain
:
Hosp Badalona Germans Trias & Pujol, Serv Cardiol, Badalona, Spain
Acena, A:
Fdn Jimenez Diaz, Serv Cardiol, Madrid, Spain
Acuna, JMG:
Hosp Clin Univ Santiago, Serv Cardiol, Santiago, Spain
Garcia-Rubira, JC:
Hosp Virgen Macarena, Serv Cardiol, Unidad Coronaria, Seville, Spain
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