Subtype-specific outcomes in cardiac amyloidosis: a national inpatient sample analysis
C Yang, G Oquendo, H Majeed, U EgolumAbstract
Background
While AL (light chain) and ATTR (transthyretin) cardiac amyloidosis both involve amyloid deposition in cardiac tissue, they differ substantially in clinical presentation, comorbidity profiles, and prognosis. Understanding subtype-specific complication patterns is essential for risk stratification, yet comparative national data remains limited.
Purpose
To compare complication profiles and outcomes between AL and ATTR cardiac amyloidosis subtypes using national hospitalization data.
Methods
A retrospective analysis of the NIS database from 2016 to 2022 identified 28,877 patients with cardiac amyloidosis using ICD-10-CM codes (25,342 AL; 3,535 ATTR). Multivariate logistic regression analyzed comparative odds of congestive heart failure, cardiogenic shock, mechanical support, ventricular arrhythmias, pulmonary hypertension, stroke, renal replacement therapy, and mortality.
Results
Patients in both major subtypes of cardiac amyloidosis were predominantly male (61%), Caucasian (62%), and between the ages 65-79 (46%). Compared to those with AL amyloidosis, patients with ATTR amyloidosis had higher odds of CHF (OR 3.74, CI 3.48-4.03, p < 0.001), cardiogenic shock (OR 4.875, CI 4.13-5.75, p < 0.001), requirement of mechanical support (OR 3.868, CI 2.04-7.39, p < 0.001), ventricular arrhythmias (OR 1.95, CI 1.527-2.499, p < 0.001), and pulmonary hypertension due to left heart disease (OR 5.05, CI 3.869-6.601, p < 0.001). Patients with AL amyloidosis had higher odds of stroke (OR 3.37, CI 3.09-3.67, p < 0.001) and renal replacement therapy (OR 2.53, CI 2.317-2.77, p < 0.001). Overall mortality was also higher in AL cardiac amyloidosis patients (OR 2.102, CI 1.999-2.21), p < 0.001).
Conclusion
ATTR and AL cardiac amyloidosis exhibit markedly different complication profiles during hospitalization. While ATTR patients experience higher rates of cardiac complications, AL patients face greater renal dysfunction, stroke risk, and mortality. Recognition of these subtype-specific patterns is essential for optimizing risk assessment and supporting the need for subtype-specific clinical approaches.