Vasoactive-Inotropic Score in Takotsubo syndrome induced cardiogenic shock

To determine the prognostic value of the Vasoactive-Inotropic Score (VIS) in patients with Takotsubo syndrome (TTS) complicated by cardiogenic shock (CS).

Retrospective cohort analysis.

Multicenter registry (RETAKO) of patients diagnosed with TTS between 2003 and 2022.

A total of 1591 patients with TTS, of which 412 (26%) developed CS.

Patients were managed according to clinical criteria, with VIS calculated based on the maximum doses of inotropic and vasoactive drugs administered within the first 24 h of CS diagnosis.

30-day and 1-year mortality rates, VIS tertile classifications.

Of the patients who developed CS, 208 received inotropic support. Patients in the highest VIS tertile had significantly higher 30-day (HR 8.80, 95% CI 1.96-39.48; p = 0.005) and 1-year (HR 4.55, 95% CI 1.11-18.63; p < 0.035) mortality compared to the lowest tertile. High VIS was also linked to increased complications, including acute kidney injury, major bleeding, and the need for mechanical circulatory support. In-hospital mortality rates were 4% for the low tertile, 14% for the middle tertile, and 47% for the high tertile (p < 0.001).

VIS is associated with worse short- and long-term outcomes in TTS complicated by CS. Further research is needed to explore potential causal pathways, if any, and to optimize therapeutic strategies for these patients.