D-31 | Takotsubo Cardiomyopathy Disparities and Outcomes in STEMI by Breast Cancer Status: Machine Learning and Propensity Score Multi-year Analysis of Over 100 Million Hospitalizations

Contributions: First 2 authors are co-first authors, contributing equally to this abstractBackgroundST-elevation myocardial infarction (STEMI) is a potentially fatal medical emergency whose care is undermined by the lower diagnosis rates of Takotsubo cardiomyopathy (TTS) mimicking STEMI, particularly in breast cancer which is hypothesized to have a higher percentage of TTS.MethodsThis case-control study is the first nationally representative analysis of mortality and cost in the above patient group with and without percutaneous coronary intervention (PCI). Machine Learning-augmented Propensity Score adjusted multivariable regression (ML-PSr) was performed on the United States’ largest all-payer hospitalized dataset, the 2016-2018 National Inpatient Sample (NIS).ResultsAmong 101,521,656 hospitalizations, 2,280,300 (2.25%) had breast cancer of whom 17,650 (0.77%) had STEMI and 5,375 (0.24%) were ultimately diagnosed with TTS. Patients with versus without breast cancer had comparable likelihood of STEMI (0.77 versus 0.95%, p=0.06) but significantly greater likelihood of TTS (0.24 versus 0.11%, p<0.001) including without PCI (0.23 versus 0.11, p<0.001) and more so with PCI (0.78 versus 0.23%, p<0.001). In STEMI, there was significantly more breast cancer diagnosed in non-whites versus whites (78.36 versus 21.64%), third highest versus lowest income quartile (26.33 versus 23.49%), metros of at least versus less than 1 million (53.88 versus 46.12%), and East North Central (19.95%), South Atlantic (17.89%), and Pacific (13.83%) regions compared to others (all p<0.001); these trends were comparable to TTS. In multivariable regression, breast cancer did not significantly increase mortality with TTS or cost.ConclusionsThis study suggests TTS is more common in breast cancer, diagnosed more with PCI, and has notable diagnosis disparities among STEMI presentations by race, income, urban density, and geography potentially subjecting such patients to unnecessary tests and procedures.DisclosuresK. A. Honan Nothing to disclose. D. J. Monlezun Nothing to disclose. C. A. Simbaqueba Clavijo Nothing to disclose. J. W. Kim Nothing to disclose. A. Badalamenti Nothing to disclose. V. Liu Nothing to disclose. A. Javaid Nothing to disclose. N. Palaskas Nothing to disclose. M. Cilingiroglu Nothing to disclose. K. Marmagkiolis Nothing to disclose. C. A. Iliescu Nothing to disclose. Contributions: First 2 authors are co-first authors, contributing equally to this abstract BackgroundST-elevation myocardial infarction (STEMI) is a potentially fatal medical emergency whose care is undermined by the lower diagnosis rates of Takotsubo cardiomyopathy (TTS) mimicking STEMI, particularly in breast cancer which is hypothesized to have a higher percentage of TTS. ST-elevation myocardial infarction (STEMI) is a potentially fatal medical emergency whose care is undermined by the lower diagnosis rates of Takotsubo cardiomyopathy (TTS) mimicking STEMI, particularly in breast cancer which is hypothesized to have a higher percentage of TTS. MethodsThis case-control study is the first nationally representative analysis of mortality and cost in the above patient group with and without percutaneous coronary intervention (PCI). Machine Learning-augmented Propensity Score adjusted multivariable regression (ML-PSr) was performed on the United States’ largest all-payer hospitalized dataset, the 2016-2018 National Inpatient Sample (NIS). This case-control study is the first nationally representative analysis of mortality and cost in the above patient group with and without percutaneous coronary intervention (PCI). Machine Learning-augmented Propensity Score adjusted multivariable regression (ML-PSr) was performed on the United States’ largest all-payer hospitalized dataset, the 2016-2018 National Inpatient Sample (NIS). ResultsAmong 101,521,656 hospitalizations, 2,280,300 (2.25%) had breast cancer of whom 17,650 (0.77%) had STEMI and 5,375 (0.24%) were ultimately diagnosed with TTS. Patients with versus without breast cancer had comparable likelihood of STEMI (0.77 versus 0.95%, p=0.06) but significantly greater likelihood of TTS (0.24 versus 0.11%, p<0.001) including without PCI (0.23 versus 0.11, p<0.001) and more so with PCI (0.78 versus 0.23%, p<0.001). In STEMI, there was significantly more breast cancer diagnosed in non-whites versus whites (78.36 versus 21.64%), third highest versus lowest income quartile (26.33 versus 23.49%), metros of at least versus less than 1 million (53.88 versus 46.12%), and East North Central (19.95%), South Atlantic (17.89%), and Pacific (13.83%) regions compared to others (all p<0.001); these trends were comparable to TTS. In multivariable regression, breast cancer did not significantly increase mortality with TTS or cost. Among 101,521,656 hospitalizations, 2,280,300 (2.25%) had breast cancer of whom 17,650 (0.77%) had STEMI and 5,375 (0.24%) were ultimately diagnosed with TTS. Patients with versus without breast cancer had comparable likelihood of STEMI (0.77 versus 0.95%, p=0.06) but significantly greater likelihood of TTS (0.24 versus 0.11%, p<0.001) including without PCI (0.23 versus 0.11, p<0.001) and more so with PCI (0.78 versus 0.23%, p<0.001). In STEMI, there was significantly more breast cancer diagnosed in non-whites versus whites (78.36 versus 21.64%), third highest versus lowest income quartile (26.33 versus 23.49%), metros of at least versus less than 1 million (53.88 versus 46.12%), and East North Central (19.95%), South Atlantic (17.89%), and Pacific (13.83%) regions compared to others (all p<0.001); these trends were comparable to TTS. In multivariable regression, breast cancer did not significantly increase mortality with TTS or cost. ConclusionsThis study suggests TTS is more common in breast cancer, diagnosed more with PCI, and has notable diagnosis disparities among STEMI presentations by race, income, urban density, and geography potentially subjecting such patients to unnecessary tests and procedures. This study suggests TTS is more common in breast cancer, diagnosed more with PCI, and has notable diagnosis disparities among STEMI presentations by race, income, urban density, and geography potentially subjecting such patients to unnecessary tests and procedures.