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Canadian Journal of Cardiology
Clinical Research| Volume 36, ISSUE 6, P860-867, June 2020

Improved Outcome of Cardiogenic Shock Triggered by Takotsubo Syndrome Compared With Myocardial Infarction

Published:October 16, 2019DOI:https://doi.org/10.1016/j.cjca.2019.10.012

      Abstract

      Background

      Cardiogenic shock (CS) is a severe complication of myocardial infarction (MI) or of takotsubo syndrome (TTS). For both diseases, CS is related to a worse long-term outcome. The outcome of CS has not been studied in a direct comparison of patients with MI and patients with TTS.

      Methods

      Mortality and cardiovascular complications were compared in patients presenting with CS based on MI or TTS between 2003 and 2017 during a follow-up of 5 years. A total of 138 patients with TTS and 532 patients with MI were included. Of these, 66 patients with MI and 25 patients with TTS developed CS (12% vs 18%, P = 0.08).

      Results

      Patients with MI and CS had more often malignant arrhythmias (74% vs 28%, P < 0.01), and need for resuscitation (80% vs 24%, P < 0.01) or death (71% vs 24%, P < 0.01) than patients with TTS and CS during the first 30 days. Although the overall rate of death remained higher in MI than in TTS (75.8% vs 52%, log rank, P < 0.01), deaths occurred in TTS constantly throughout the follow-up time, but not in MI. The incidence of heart failure increased in MI but not in TTS (31.8% vs 4%, P < 0.01) during follow-up.

      Conclusions

      Patients with MI and CS have a worse prognosis than patients with TTS and CS. This is driven by cardiovascular events or death during the first 30 days after the index event. However, patients with TTS and CS show high mortality as well, especially during long-term follow-up.

      Résumé

      Contexte

      Le choc cardiogénique (CC) est une complication grave de l’infarctus du myocarde (IM) et du syndrome de Takotsubo (STT). Dans les deux cas, le CC est associé à une issue défavorable à long terme. L’issue du CC n’a jamais fait l’objet d’une comparaison directe entre patients ayant subi un IM et patients ayant subi un STT.

      Méthodologie

      Les auteurs ont comparé la mortalité et les complications cardiovasculaires chez des patients ayant présenté un CC secondaire à un IM ou à un STT entre 2003 et 2017, au cours d’un suivi de 5 ans. Au total, 138 patients ayant subi un STT et 532 patients ayant subi un IM ont été inclus dans l’étude. Parmi eux, 66 patients ayant subi un IM et 25 patients ayant subi un STT ont présenté un CC (12 % vs 18 %, p = 0,08).

      Résultats

      Au cours des 30 premiers jours, les patients ayant subi un IM et un CC ont plus souvent présenté des arythmies malignes (74 % vs 28 %, p < 0,01), nécessité une réanimation (80 % vs 24 %, p < 0,01) ou succombé (71 % vs 24 %, p < 0,01) que les patients ayant subi un STT et un CC. Bien que le taux de décès global soit demeuré plus élevé chez les patients ayant subi un IM que chez ceux ayant subi un STT (75,8 % vs 52 %, test du log-rank, p < 0,01), les décès sont survenus de manière constante pendant toute la période de suivi dans le groupe STT, mais pas dans le groupe IM. L’incidence de l’insuffisance cardiaque a augmenté dans le groupe IM durant la période de suivi, mais pas dans le groupe STT (31,8 % vs 4 %, p < 0,01).

      Conclusions

      Le pronostic est plus sombre chez les patients qui ont subi un IM et un CC que chez ceux qui ont subi un STT et un CC, en raison du risque de survenue d’événements cardiovasculaires et de décès dans les 30 jours suivant l’événement de référence. Toutefois, les patients ayant subi un STT et un CS affichent aussi un taux de mortalité élevé, en particulier durant le suivi à long terme.
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