DEMOGRAPHICS AND OUTCOMES OF PATIENTS WITH TAKOTSUBO SYNDROME AND RHEUMATOID ARTHRITIS

Abstract

Therapeutic Area

ASCVD/CVD in Special Populations

Background

Takotsubo syndrome (TS) features transient left ventricular apical dysfunction. Physical or emotional stress is the most common cause of TS. The exact pathophysiological mechanism of TS remains unclear, and some hypotheses include myocardial edema and inflammation, coronary vasospasm, microcirculatory dysfunction, catecholamine surge, and sympathetic overdrive as possible mechanisms. While the potential link between rheumatological conditions and TS is suspected, there is a general lack of descriptions of the clinical implications of this association.

Methods

The US National Inpatient Database was queried from 2011 to 2019 for relevant ICD-9 and -10 diagnostic and procedural codes. We identified patients admitted with TS who had a coronary angiogram. We then excluded those who underwent coronary percutaneous coronary intervention (PCI), coronary artery bypass graft (CAGB) or had a diagnosis of myocarditis. We compared baseline characteristics and in-hospital outcomes of patients with TS with vs. without rheumatoid arthritis (RA).

Results

We identified 126,475 patients with TS, of which 4,001 (3.2%) had concomitant RA.

Patients with TS and RA were older (68.7 vs. 66.6 years, p ≤0.001), more likely to be of female sex (95.7% vs. 88%, p ≤0.001), and white in race (85.1% vs. 82.8%, p ≤0.001) compared to patients without RA. Those with RA had more anxiety (22.4% vs. 20.1%, p ≤0.001), major depressive disorder (20.3% vs. 17%, p ≤0.001) prior history of bariatric surgery (2.5% vs. 1.5%, p ≤0.001), cirrhosis (2.2% vs. 1.4%, p ≤0.001), pulmonary hypertension (8.1% vs. 5.7%, p ≤0.001), and obstructive sleep apnea (7.9% vs. 5.3%, p ≤0.001) compared to patients without RA.

Regarding in-hospital outcomes, after adjusting for age, sex, and race, there was no difference in all-cause mortality within groups (1.6% vs. 2%, p =0.09).

However, those with RA were more likely to have complications like heart failure (42.3% vs. 39%, p <0.001, 1.1 [1.05-1.2]), sepsis 6.9% vs. 5%, p <0.001, 1.5 [1.3-1.7]), and supraventricular tachycardia (3.1% vs. 2.1%, p <0.001, 1.5 [1.3-1.8]). They were less likely to have a cardiac arrest, cardiogenic shock, or ventricular fibrillation, and required less cardioversion compared to patients without RA.

Conclusions

The prognosis of TS in patients with RA appears to be similar to that of patients without RA. Due to the nature of this study, we could not stratify according to disease severity or disease duration in patients with RA, which have been reported to influence comorbidities and long-term patient outcomes significantly.