Effects of pharmacological interventions on mortality in patients with Takotsubo syndrome: a report from the SWEDEHEART registry

Petur Petursson, Eduard Oštarijaš, Björn Redfors, Truls Råmunddal, Oskar Angerås, Sebastian Völz, Araz Rawshani, Kristina Hambraeus, Sasha Koul, Joakim Alfredsson, Henrik Hagström, Henareh Loghman, Robin Hofmann, Ole Fröbert, Tomas Jernberg, Stefan James, David Erlinge, Elmir Omerovic*

*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

1 Citation (Scopus)

Abstract

AIMS: Takotsubo syndrome (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 AND RESULTS: We analysed 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 patients who underwent coronary angiography between 2009 and 2016. In total, we identified 1724 patients with TS among 228 263 individuals in the registry. The average age was 66 ± 14 years, and 77% were female. Nearly half of the TS patients (49.4%) presented with non-ST-elevation acute coronary syndrome, and a quarter (25.9%) presented with ST-elevation myocardial infarction. Most patients (79.1%) had non-obstructive coronary artery disease on angiography, while 11.7% had a single-vessel disease and 9.2% had a multivessel disease. All patients received at least one pharmacological intervention; most of them used beta-blockers (77.8% orally and 8.3% intravenously) or antiplatelet agents [aspirin (66.7%) and P2Y 12 inhibitors (43.6%)]. According to the Kaplan-Meier estimator, the probability of all-cause mortality was 2.5% after 30 days and 16.6% after 6 years. The median follow-up time was 877 days. Intravenous use of inotropes and diuretics was associated with increased 30 day mortality in TS [hazard ratio (HR) = 9.92 (P < 0.001) and HR = 3.22 (P = 0.001), respectively], while angiotensin-converting enzyme inhibitors and statins were associated with decreased long-term mortality [HR = 0.60 (P = 0.025) and HR = 0.62 (P = 0.040), respectively]. Unfractionated and low-molecular-weight heparins were associated with reduced 30 day mortality [HR = 0.63 (P = 0.01)]. Angiotensin receptor blockers, oral anticoagulants, P2Y 12 antagonists, aspirin, and beta-blockers did not statistically correlate with mortality.

CONCLUSIONS: Our findings suggest that some medications commonly used to treat TS are associated with higher mortality, while others have 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.

Original languageEnglish
JournalESC Heart Failure
Volume11
Issue3
Pages (from-to)1720-1729
Number of pages10
ISSN2055-5822
DOIs
Publication statusPublished - Jun 2024
Externally publishedYes

Keywords

  • Mortality
  • Pharmacological interventions
  • Prognosis
  • Stress cardiomyopathy
  • Takotsubo cardiomyopathy
  • Takotsubo syndrome
  • Follow-Up Studies
  • Humans
  • Male
  • Adrenergic beta-Antagonists/therapeutic use
  • Takotsubo Cardiomyopathy/drug therapy
  • Coronary Angiography
  • Survival Rate/trends
  • Female
  • Registries
  • Aged
  • Retrospective Studies
  • Sweden/epidemiology

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