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