Why the study?
Takotsubo cardiomyopathy mimics acute myocardial infarction, but the effects of pharmacological interventions on short- and long-term mortality in these patients required investigation.
Do pharmacological interventions affect short- and long-term mortality in patients with takotsubo syndrome?
Do pharmacological interventions affect short- and long-term mortality in patients with takotsubo syndrome?
In patients with takotsubo syndrome, treatment with ACE inhibitors and statins is associated with decreased long-term mortality, while inotropes, diuretics, and digoxin are associated with increased mortality.
Answers are grounded in this paper and cite their sources.
Associations in takotsubo syndrome warrant cautious interpretation and should not change practice; leaves open need for randomized confirmation.
Aim Takotsubo cardiomyopathy (TS) is a heart condition mimicking acute myocardial infarction. TS is characterized by a sudden weakening of the heart muscle, usually triggered by physical or emotional stress. In this study, we aimed to investigate the effect of pharmacological interventions on short– and long-term mortality in patients with TS. Methods We analyzed data from the SWEDEHEART (The Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies) registry, which included 1,724 patients with TS among 228,263 unique individuals who underwent coronary angiography between 2009 and 2016. The majority of patients were female (77.0%), and the average age was 66 ± 14 years. Results Nearly half of the TS patients (49.4%) presented with non-ST-elevation acute coronary syndrome and a quarter (25.9%) presented as ST-elevation myocardial infarction. Most patients had non-obstructive coronary artery disease on angiography, while 11.7% had a single-vessel disease and 9.2% had multivessel disease. All patients received at least one pharmacological intervention, most used being beta-blockers or antiplatelet agents. All-cause mortality rates were 3.9% after 30-days and and 16.7% at long-term follow-up (median 877 days). Intravenous use of inotropes, diuretics, and orally administered digoxin were associated with increased mortality in TS, while ACE-I and statins were associated with decreased long-term mortality. Unfractionated and low-molecular-weight heparin (UH/LMWH) were associated with reduced 30-day mortality. However, medications such as ARBs, oral anticoagulants, P2Y12 antagonists, aspirin, and beta-blockers did not statistically correlate with mortality. Conclusion Our findings suggest that some medications commonly used to treat TS are associated with higher mortality while others with lower mortality. These results could inform clinical decision-making and improve patient outcomes in TS. Further research is warranted to validate these findings and to identify optimal pharmacological interventions for patients with TS.
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Pétursson et al. (2023) studied this question.
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