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Demographic and Co-Morbid Predictors of Stress (Takotsubo) Cardiomyopathy

      Little is known about the epidemiology of stress (takotsubo) cardiomyopathy (SC). We used a 3-arm case–control study to assess differences in demographic and co-morbid predictors of SC compared to orthopedic controls and myocardial infarction (MI) controls to characterize (1) population-level predictors of SC generally and (2) differences and similarities in determinants of SC compared to MI. We included data on all discharges of patients diagnosed with SC from the 2008 to 2009 National Inpatient Samples and randomly selected 1-to-1 age-matched controls from patients hospitalized with MI and patients hospitalized with joint injuries after trauma. We used McNemar tests to assess differences in demographic characteristics and co-morbidities between patients with SC and controls. There were 24,701 patients with SC in our study. Of patients with SC, 89.0% were women compared to 38.9% of patients with MI and 55.7% of orthopedic controls. Patients with SC were more likely to be white and to reside in wealthier ZIP codes compared to MI and orthopedic controls. Patients with SC were less likely to have cardiovascular risk factors compared to MI and orthopedic controls but were more likely to have had histories of cerebrovascular accidents, drug abuse, anxiety disorders, mood disorders, malignancy, chronic liver disease, and sepsis. In conclusion, demographic and co-morbid predictors of SC differ substantially from those of MI and may be of interest to providers when diagnosing SC. Several co-morbid risk factors predictive of SC may operate by increased catecholamines.
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      Linked Article

      • Takotsubo Cardiomyopathy: Overrepresentation of Cases
        American Journal of CardiologyVol. 111Issue 6
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          I read the report “Demographic and Co-Morbid Predictors of Stress (Takotsubo) Cardiomyopathy.”1 The investigators stated that 24,701 cases of stress cardiomyopathy were identified from the 2008 and 2009 Nationwide Inpatient Sample databases2 using International Classification of Diseases, Ninth Revision, Clinical Modification code of 42983. This number of cases appears too large, considering the rarity of the condition. It probably included admissions for acute myocardial infarction, considering that the 2 conditions have very similar clinical presentations.
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