IMPORTANCE: Takotsubo syndrome (TTS) is an acute reversible heart failure syndrome featured by significant rates of in-hospital complications (IHCs). There is a lack of data for risk stratification during hospitalization. OBJECTIVES: To derive a simple clinical score for risk prediction of IHCs in patients with TTS. DESIGN, SETTING, PARTECIPANTS: 1007 consecutive patients with TTS were enrolled in the GEIST (GErman and Italian STress Cardiomyopathy) registry. The score was developed using a stepwise multivariable regression analysis. The RE-TAKO (Spanish REgistry for TAKOtsubo cardiomyopathy) registry population (n=946 patients), also enrolling patients with TTS, was used for external score validation. MAIN OUTCOMES AND MEASURES: Four variables were identified as independent predictors of IHCs and were used for the score: male gender, history of neurological disorder, right ventricular involvement and left ventricular ejection fraction (LVEF). GEIST prognosis score was derived providing 20 points for male gender and history of neurological disorders, 30 points for right ventricle (RV) involvement, and subtracting the value in percent of LVEF. Score accuracy at ROC curve analysis 0.71, negative predictive power 87% in case of score values <20. External validation in the RETAKO population showed an area under the curve of 0.73 (p=n.s. vs GEIST derivation cohort). RESULTS: Overall rate of IHCs in the GEIST population was 23% % (death 4%, pulmonary edema 6%, invasive ventilation 6%, cardiogenic shock 9%). Stratification into 3 risk groups (<20 vs 20-40 and >40 points) classified 41% of patients as at low risk, 44% as intermediate, and 15% as high risk. The observed IHC rates were 13%, 24% and 59%, respectively (p for trend <0.001). After 2.6 years follow-up patients with IHCs showed higher rates of mortality (40% vs 10%, p=0.01). CONCLUSIONS AND RELEVANCE: the GEIST prognostic score, a simple tool based on four variables, may be useful in early risk stratification of TTS. High-risk TTS patients may require intensive care unit stay, meanwhile low risk TTS could be discharged within few days. IHCs in TTS patients may be associated with increased risk of mortality at long-term follow-up.
|Titolo:||Risk Stratification for in-Hospital Complications in Patients with Takotsubo Syndrome: the Geist Score|
|Data di pubblicazione:||30-apr-2019|
|Appare nelle tipologie:||8.1 Tesi di dottorato|