High-risk patients may require ICU stay while low-risk patients could get early discharge
Select echocardiographic and clinical risk variables were significantly associated with increased risk of in-hospital complications for patients with takotsubo syndrome, researchers found.
For the German and Italian Stress Cardiomyopathy (GEIST) cohort, the overall incidence of in-hospital complications was 23.3%, specifically 9.1% for cardiogenic shock, 5.8% for pulmonary edema, 6.4% for invasive ventilation, and 4.0% for death, reported Natale Daniele Brunetti, MD, PhD, of the University of Foggia in Italy, and colleagues in JAMA Cardiology.
For the Spanish Registry for Takotsubo Cardiomyopathy (RETAKO) group, the rate of in-hospital complication was 20.4%. Nearly 2% of complications were related to death, 10.0% for cardiogenic shock, 6.4% for invasive mechanical ventilation, and 8.6% for pulmonary edema, they found.
Left ventricular ejection fraction (LVEF), right ventricular involvement, male sex, and history of neurologic disorder were considered to be predictors of in-hospital complications based on the GEIST score, which is used to predict in-hospital complications, they added.
"High risk patients may require an intensive care stay while low risk patients could be discharged earlier," co-author Francesco Santoro, MD, PhD, also of the University of Foggia, told MedPage Today.
The study results suggested that assessment "of 4 clinical and echocardiographic variables may identify patients with Takotsubo syndrome who have a high risk for in-hospital complications," the authors wrote.
Although considered to be a fairly benign syndrome, the information has shown increased rates of adverse and in-hospital events at long-term follow-up among patients with Takotsubo syndrome, the researchers noted.
Diabetes, male sex, physical stressor, and right ventricular involvement are reported factors linked with in-hospital complications in prior takotsubo syndrome groups, they added. "However, data on in-hospital risk stratification are poor and mainly come from small, single-center study cohorts."
The researchers evaluated 829 patients in the RETAKO validation cohort and 772 patients in the GEIST derivation cohort at 12 institutions in Germany and Italy. Mean patient age was 69.9. All patients underwent LV and coronary angiography due to suspected takotsubo syndrome.
The GEIST prognosis score was developed by providing 30 points for right ventricular involvement, then subtracting the value in percent of LVEF, which was from 0.15 to 0.70, and providing 20 points each for history of neurologic disorders and male sex.
Other data showed that for the derivation of the GEIST prognosis score, patients were mixed into three risk groups with 14.8% having high-risk complications, 44.3% having intermediate complications, and 40.9% having low-risk complications. The observed complication rates were 58.8% for high-risk patients, 23.4% for intermediate-risk patients, and 12.7% for low-risk patients.
Of the 829 patients with complete data in the GEIST validation cohort, 9.4% were in the high-risk group, 39.1% were in the intermediate-risk group, and 51.5% were in the low-risk group. In-hospital complications were 52.6% for the high-risk group, 29.6% for the intermediate-risk group, and 9.6% for the low-risk group.
Patients without in-hospital complications had significantly lower rates of death compared with patients with complications (10.0% vs 40.1%, P=0.01) after a mean follow-up of 2.6 years.
Study limitations included the fact that the GEIST score is similar to other clinical scores, but does not exceed 70% and some high-risk patients may have been overlooked. "Another limitation is that a certain number of patients were excluded from the analyses because of missing data regarding the score variables (23.3%), mainly owing to the lack of data concerning RV [right ventricular] involvement and/or history of neurologic disorders," Brunetti's group wrote.
Brunetti, Santoro, and co-authors disclosed no relevant relationships with industry.
Source Reference: Santoro F, et al "Assessment of the german and italian stress cardiomyopathy score for risk stratification for in-hospital complications in patients with takotsubo syndrome" JAMA Cardiol 2019; DOI: 10.1001/jamacardio.2019.2597.
Read the original article on Medpage Today: Four Factors May Up In-Hospital Events in Takotsubo Syndrome