Clinical Characteristics and Outcomes of Cardiogenic Shock in Acute Myocarditis Versus Takotsubo Cardiomyopathy: A Propensity Matched Nationwide Analysis.

BACKGROUND: Cardiogenic shock (CS) is a life-threatening complication of acute myocarditis (MC) and takotsubo cardiomyopathy (TC). Comparative data on mechanical circulatory support (MCS) utilization and outcomes between these cohorts remain undefined. METHODS: Using the National Inpatient Sample 2020-2022 database, adult hospitalizations with concomitant diagnoses of CS and MC (MC-CS) or TC (TC-CS) were identified. Patients with cardiac arrest, acute coronary syndrome, coronary revascularization, or incomplete records were excluded. A 1:1 propensity score match was performed to balance demographics, baseline comorbidities, and hospital characteristics. The primary outcome was in-hospital mortality. Secondary outcomes included MCS and resource utilization. RESULTS: Among 7080 hospitalizations (MC-CS: n = 2825; TC-CS: n = 4255), patients with MC-CS were younger (46.5 vs 62.9 years) and predominantly male (58.0% vs 27.5%). Propensity score matching yielded 2435 balanced pairs. In the matched cohort, hospital mortality (26.5% vs 26.7%; P = .97) and length of stay (16.2 vs 16.0 days; P = .96) were comparable between groups. MC-CS was associated with higher use of temporary MCS (30.0% vs 10.5%; P < .001), including extracorporeal membrane oxygenation (14.2% vs 2.3%, P = .003), Impella (14.6% vs 6.8%, P = .04), and intra-aortic balloon pump (13.6% vs 3.1%, P = .003). Total hospital charges were higher for MC-CS ($435,121 vs $288,522; P = .008). CONCLUSIONS: In patients with CS, hospital mortality and length of stay are comparable between MC-CS and TC-CS when matched for baseline clinical risk. However, MC-CS involves nearly 3-fold higher utilization of MCS alongside higher hospital charges.