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Impact of family history of coronary artery disease on clinical outcomes in Takotsubo cardiomyopathy
  1. Pengyang Li1,
  2. Chengyue Jin2,
  3. Can Cui3,
  4. Peng Cai4,
  5. Shamita Alisa Manohar1,
  6. Ling Jin5,
  7. Xin Wei1,
  8. Su Pan6,
  9. Richard A F Dixon6,
  10. Qi Liu6
  1. 1Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA
  2. 2Department of Medicine, Westchester Medical Center, Valhalla, New York, USA
  3. 3Department of Immunobiology, Yale University School of Medicine, New Haven, Connecticut, USA
  4. 4Department of Mathematical Sciences, Worcester Polytechnic Institute, Worcester, Massachusetts, USA
  5. 5Department of Medicine, Metrowest Medical Center, Framingham, Massachusetts, USA
  6. 6Wafic Said Molecular Cardiology Research Laboratory, Texas Heart Institute, Houston, Texas, USA
  1. Correspondence to Dr Qi Liu, Texas Heart Institute, Houston, Texas, USA; qliu{at}texasheart.org

Abstract

Family history of coronary artery disease (FHxCAD) is a critical risk factor for CAD, underscoring the contribution of genetic factors to disease pathogenesis and susceptibility. Takotsubo cardiomyopathy (TCM) simulates the clinical features of and frequently coexists with CAD. However, the association between FHxCAD and TCM is unclear. Here, we retrospectively examined the impact of FHxCAD on in-hospital outcomes of patients with TCM. Using the National Inpatient Sample database (2016–2018), we identified 4733 patients admitted to hospital with a primary diagnosis of TCM. We compared in-hospital outcomes and complications between TCM patients with (n=646, 13.7%) and without FHxCAD (n=646) in the unmatched and in a propensity-score matched cohort (1:1 ratio). TCM with FHxCAD patients had a reduced incidence of cardiogenic shock, acute kidney injury (AKI), and acute respiratory failure (ARF); lower mortality rates; shorter length of stay (LOS); and decreased total charge compared with TCM without FHxCAD patients (p<0.05). In the matched cohort, TCM with FHxCAD patients (vs TCM without FHxCAD patients) had a lower incidence of cardiogenic shock (2.2% vs 6.3%, p<0.001; OR 0.33, 95% CI 0.18 to 0.61), AKI (5.1% vs 8.7%, p=0.016; OR 0.57, 95% CI 0.36 to 0.88), and ARF (5.7% vs 12.7%, p<0.001; OR 0.42, 95% CI 0.28 to 0.63); decreased in-hospital mortality (<11% vs 3.1%, p=0.002; OR 0.2, 95% CI 0.07 to 0.57); shorter LOS (2.66±1.96 days vs 3.40±3.05 days, p<0.001); and a reduced total charge (p=0.001), respectively. FHxCAD was associated with favorable outcomes in both unmatched and propensity-matched cohorts.

  • coronary artery disease
  • hospitals
  • cardiomyopathies

Data availability statement

Data are available in a public, open access repository. Reference 20: Agency for Healthcare Research and Quality. HCUP Databases. Healthcare Cost and Utilization Project (HCUP) (website). August 2018. Available at: www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed 13 December 2018.

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Data availability statement

Data are available in a public, open access repository. Reference 20: Agency for Healthcare Research and Quality. HCUP Databases. Healthcare Cost and Utilization Project (HCUP) (website). August 2018. Available at: www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed 13 December 2018.

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Footnotes

  • PL and CJ contributed equally.

  • Contributors Conception and design: PL, CJ; Administrative support: SAM, CC; Provision of study materials or patients: None; Collection and assembly of data: None; Data analysis and interpretation: PC, PL, CJ, CC, XW, QL; Manuscript writing: all authors; and Final approval of manuscript: all authors. Guarantor: QL.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.