Differences in Clinical Features and In-Hospital Outcomes of Older Adults with Tako-Tsubo Cardiomyopathy

• Autores: Rodolfo Citro, Fausto Rigo, Mario Previtali, Quirino Ciampi, Francesco Antonini Canterin, Gennaro Provenza, Roberta Giudice, Marco Mariano Patella, Olga Vriz, Rahul Mehta, Cesare Baldi, Rajendra H. Mehta, Eduardo Bossone
• Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 60, Nº. 1, 2012, págs. 93-98
• Idioma: inglés
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• Resumen

  • Objectives: To describe the clinical characteristics and in-hospital outcomes of older adults with tako-tsubo cardiomyopathy (TTC).

    Design: Partially retrospective, partially prospective observational study.

    Setting: Eleven Italian referral cardiac centers included in the Tako-tsubo Italian Network.

    Participants: One hundred ninety consecutive individuals with TTC (92.1% female, mean age 66) were divided into three groups according to age (<65, n = 78; 65�74, n = 61; ?75, n = 51).

    Measurements: Clinical findings and in-hospital outcomes were evaluated in each group.

    Results: Participants aged 65 and older had a greater prevalence of hypertension (P = .001) and a lower glomerular filtration rate (P < .001), and those aged 65 to 74 had a greater prevalence of psychiatric disorders (P = .01), ST-segment elevation on admission (P = .01) and a cerebrovascular disease (P = .003) than those younger than 65. Despite similar left ventricular ejection fraction (LVEF) on admission (P = .26), the oldest group had a lower LVEF at discharge (P = .03). Inotropic agents were used more frequently in older adults (P = .03). In-hospital composite adverse events (all-cause death, acute heart failure, life-threatening arrhythmias, stroke, and cardiogenic shock; P = .03) and overall complications (P = .004) were more common in participants aged 75 and older. Overall in-hospital mortality was low (2.8%) but was more prevalent in participants aged 75 and older (6.3%). On multivariate analysis, age of 75 and older (hazard ratio (HR) = 2.45, 95% confidence interval (CI) = 1.28�5.82, P = .04) and LVEF on admission (HR = 0.874, 95% CI = 0.81�0.95, P < .001) were the only independent predictors of in-hospital adverse events.

    Conclusion: The clinical profile of participants aged 75 and older with TTC was different from that of those younger than 75 with TTC, and they had a higher in-hospital complication rate.