Impact of mechanical circulatory support on outcomes in Takotsubo syndrome complicated by cardiogenic shock: Insights from the RETAKO registry

• Published in: International journal of cardiology 2025-01, Vol.419, p.132681, Article 132681
• Main Authors: Uribarri, Aitor, Vazirani, Ravi, Delia, Manuel Almendro, Tomasino, Marco, Fernández-Cordón, Clara, Martín, Agustín, Blanco-Ponce, Emilia, Salamanca, Jorge, Corbí-Pascual, Miguel, Vedia, Oscar, Duran-Cambra, Albert, Becerra-Muñoz, Víctor Manuel, Lluch-Requerey, Carmen, Raposeiras-Roubin, Sergio, Guillén-Marzo, Marta, Lopez-País, Javier, Pérez-Castellanos, Alberto, Mayordomo, Petra Sanz, Martínez-Sellés, Manuel, Vila-Sanjuán, Sofía, Ródenas-Alesina, Eduard, Núñez-Gil, Iván J.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Cardiogenic shock; Extracorporeal Membrane Oxygenation - methods; Female; Heart failure; Heart-Assist Devices; Hospital Mortality - trends; Humans; Inotropic agents; Intra-Aortic Balloon Pumping - methods; Left ventricular outflow tract obstruction; Male; Middle Aged; Prospective Studies; Registries; Shock, Cardiogenic - etiology; Shock, Cardiogenic - mortality; Shock, Cardiogenic - therapy; Takotsubo Cardiomyopathy - complications; Takotsubo Cardiomyopathy - therapy; Takotsubo syndrome; Treatment Outcome
• ISSN: 0167-5273; 1874-1754; 1874-1754
• DOI: 10.1016/j.ijcard.2024.132681

Cardiogenic shock (CS) complicates Takotsubo syndrome (TTS), significantly affecting patient outcomes. Since avoiding catecholamines, particularly inotropic agents, is recommended in TTS, temporary mechanical circulatory support (MCS) shows promise as a bridge to recovery. However, there is no prospective data on its use in TTS. Patients from the prospective nationwide RETAKO registry were included and divided based on the use and type of MCS. From a national TTS registry, 1591 consecutive patients were initially enrolled between 2003 and 2022. Of these, 322 patients (20.2 %) developed CS, and 31 (9.6 %) were treated with MCS [20 intra-aortic balloon pump (IABP) (64.5 %), 8 veno-arterial extracorporeal membrane oxygenation (25.8 %), and 3 Impella-CP (9.7 %)]. Compared to CS patients managed only with drugs, MCS recipients exhibited a more severe clinical profile, with worse ventricular function and more right ventricular involvement. Despite encountering more complications, such as major bleeding and atrial fibrillation, MCS did not significantly influence in-hospital mortality (19.4 % in the MCS group vs 13.1 % in the no MCS group, p = 0.33). After adjusting for other predictors of in-hospital mortality (invasive mechanical ventilation, inotropic-vasoactive score, age, and SCAI stage), MCS was not associated with higher mortality. Approximately 10 % of TTS patients complicated by CS were treated with MCS. Despite their more severe CS, patients treated with MCS had similar in-hospital mortality rates as those treated only with drugs, suggesting a potential benefit of MCS in selected cases. [Display omitted] •Takotsubo Syndrome (TTS) can lead to cardiogenic shock in up to 20 % of cases.•Mechanical circulatory support (MCS) was used in 9.6 % of TTS cases with cardiogenic shock.•MCS patients had higher in-hospital complications, but mortality rates were similar.•No significant difference in one-year survival was observed between MCS and non-MCS groups.