Introduction:
Several studies have described age-related variation in clinical outcomes for Takotsubo Syndrome (TTS) patients with conflicting results. The present study aimed at analyzing the influence of age on TTS outcomes from a large national database.
Methods:
The National Inpatient Sample (2009-2015) was used to identify patients with a primary admitting diagnosis of TTS. All patients were stratified according to age and categorized into 3 groups (younger: ≤ 50 years, middle age: 51-74 years, and older: ≥ 75 years). Data on patient demographics, comorbidities, hospital characteristics, and in-hospital complications were extracted.
Results:
Of 40,326 patients, 11.2% of the patients were ≤ 50 years of age, 59.95% were 51 to 74 years of age, and 29.0% were ≥75 years of age. Young patients were more likely to be male, and less likely to have hypertension, diabetes mellitus, atrial fibrillation, and heart failure (Table). Our analysis showed that in-hospital mortality was higher in the older age group compared to the middle and younger age group. However, younger patients were more likely to have cardiogenic shock, cardiac arrest, invasive ventilation, circulatory support, and ventricular arrhythmias (Table). On multivariate analysis, using middle age as a reference group, older age was independently associated with in-hospital mortality (OR, 1.68; 95% CI: 1.37-2.07), while young age was independently associated with cardiac arrest (OR, 2.92; 95% CI: 2.33-3.63), and ventricular arrhythmias (OR, 2.09; 95% CI: 1.81-2.43).
Conclusions:
Our study reveals that young patients with TTS are critically ill with higher rates of cardiogenic shock, cardiac arrest, circulatory support, invasive ventilation, and ventricular arrhythmias. However, in-hospital mortality was still higher in the older age group. Further studies are needed to better understand the pathophysiological mechanism of relatively poor outcomes in younger TTS patients.
Sudden Cardiac Arrest as the First Manifestation of Takayasu Arteritis