Minerva Cardioangiologica 2021 Jan 11

DOI: 10.23736/S0026-4725.20.05456-0

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Clinical features and outcomes between African American and Caucasian patients with Takotsubo Syndrome

Krishna RAVINDRA ¹, Marco G. DEL BUONO ^{1, 2} ✉, Juan G. CHIABRANDO ^{1, 3, 4}, Peter WESTMAN ¹, Edoardo BRESSI ¹, Dinesh KADARIYA ¹, Curtis MAEHARA ¹, Megan DELL ¹, Liangsuo MA ⁵, Jessie van WEZENBEEK ¹, F. Gerard MOELLER ⁷, Lori KEYSER-MARCUS ⁷, Larry D. KEEN ⁶, Tamas S. GAL ⁸, Antonio ABBATE ¹

¹ Pauley Heart Center, Virginia Commonwealth University Hospital, Richmond, VA, USA; ² Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; ³ Interventional Cardiology Service, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; ⁴ Laboratory of Applied Health Statistics (LEACS), School of Medicine, University of Buenos Aires, Buenos Aires, Argentina; ⁵ Department of Radiology, Virginia Commonwealth University Hospital, Richmond, VA, USA; ⁶ Department of Psychology, Virginia State University, Petersburg, VA, USA; ⁷ Department of Psychiatry, Virginia Commonwealth University Hospital, Richmond, VA, USA; ⁸ Department of Biostatistics, Virginia Commonwealth University Hospital, Richmond, VA, USA

BACKGROUND: Takotsubo syndrome (TS) is an acute, reversible form of heart failure, often mimicking an acute coronary syndrome (ACS). Data regarding racial differences in TS are inconsistent. The aim is to assess clinical features associated with unfavorable in-hospital outcomes between African American (AA) and Caucasian (CAU) patients.
METHODS: A retrospective electronic health record query identified 44 AA patients and 110 CAU patients with a diagnosis of TS. Our primary outcome was a composite of death, stroke, and cardiogenic shock during hospitalization. Variables associated with an increased risk of the primary composite outcomes were included in a logistic regression model.
RESULTS: Compared to CAU patients, AA patients were a more comorbid population, and presented a higher prevalence of history of illicit drug use (27.3% vs 13.6% p=0.044). There were no significant differences regarding in-hospital complication rates between AA and CAU patients. In the logistic regression model, infection was associated with greater risk of developing the primary outcome in AA patients (OR=7.26 95% CI [1.22-43.17], p=0.029), whereas angina was a protective factor (OR=0.11 95% CI [0.02-0.65], p=0.015). In CAU patients, severely depressed ejection fraction and worse peak creatinine during hospitalization increased risk of developing the primary outcome (OR=5.88 95% CI [2.01-17.17], p<0.001 and OR=1.64 95% CI [1.15-2.58], p=0.031, respectively). Meanwhile, emotional stressors were protective (OR=0.16 95% CI [0.03-0.88], p=0.004).
CONCLUSIONS: Despite experiencing the same rate of in-hospital complications, the clinical profiles of AA patients are distinct from CAU patients admitted for TS, and clinical variables correlated with worse in-hospital outcomes also differ by race.

KEY WORDS: Takotsubo cardiomyopathy; Cardiomyopathies; Complications; Heart failure; Continental population groups