Long-term Risk of Death and Hospitalization in Patients With Heart Failure and Takotsubo Syndrome: Insights From a Nationwide Cohort

Butt, Jawad H; Bang, Lia E.; Rørth, Rasmus; Schou, Morten; Kristensen, Søren Lund; Yafasova, Adelina; Havers-Borgersen, Eva; Vinding, Naja Emborg; Jessen, Nicolai; Kragholm, Kristian; Torp‐Pedersen, Christian; Køber, Lars; Fosbøl, Emil Loldrup

doi:10.1016/j.cardfail.2022.02.002

Cited by 19 publications

(13 citation statements)

References 30 publications

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“…Effects of pharmacological interventions on short-and long-term mortality in patients with Takotsubo syndrome: a report from the SWEDEHEART registry ARBs, P2Y 12 antagonists, and oral anticoagulants were neutral. Previous studies [20][21][22] have indicated that the mortality rates in patients with TS are comparable with those observed in patients with MI. However, there appears to be a significant disparity in mortality rates between different countries and even within the same country across different regions.…”

Section: Discussionmentioning

confidence: 76%

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

Petursson,

Oštarijaš,

Redfors

et al. 2024

ESC Heart Failure

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AimsTakotsubo 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 resultsWe 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 P2Y12 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, P2Y12 antagonists, aspirin, and beta‐blockers did not statistically correlate with mortality.ConclusionsOur 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.

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Section: Discussionmentioning

confidence: 76%

“…Previous studies 20–22 have indicated that the mortality rates in patients with TS are comparable with those observed in patients with MI. However, there appears to be a significant disparity in mortality rates between different countries and even within the same country across different regions 22 .…”

Section: Discussionmentioning

confidence: 78%

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

Petursson,

Oštarijaš,

Redfors

et al. 2024

ESC Heart Failure

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“…Previous studies [17][18][19] , have indicated that the mortality rates in patients with TS are comparable to those observed in patients with MI. However, there appears to be a significant disparity in mortality rates between different countries and even within the same country across different regions 19 .…”

Section: Discussionmentioning

confidence: 81%

Effects of pharmacological interventions on short- and long-term mortality in patients with takotsubo syndrome: a report from the SWEDEHEART registry

Petursson,

Oštarijaš,

Redfors

et al. 2023

Preprint

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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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“…However, one small observational case-control study, showed that patients with prior TTS had reduced exercise capacity, impaired left ventricular strain patterns and reduced cardiac energetic status compared with age-, sex-, and comorbidity-matched controls even though they were included in the study more than 12 months after the index TTS event [36]. This might help to explain the higher incidence of heart failure during follow-up in TTS patients as compared with SCAD patients [37]. Alternatively, this outcome could be also partially explained by age and comorbidity burden.…”

Section: Discussionmentioning

confidence: 99%

Non-atherosclerotic acute cardiac syndromes: spontaneous coronary artery dissection and Takotsubo syndrome. Comparison of long-term clinical outcomes

Salamanca,

García-Guimaraes,

Sabaté

et al. 2023

Coronary Artery Disease

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Background Spontaneous coronary artery dissection (SCAD) and Takotsubo syndrome (TTS) constitute two common causes of nonatherosclerotic acute cardiac syndrome particularly frequent in women. Currently, there is no information comparing long-term clinical outcomes in unselected patients with these conditions. Methods We compared the baseline characteristics, in-hospital outcomes, and the 12-month and long-term clinical outcomes of two large prospective registries on SCAD and TTS. Results A total of 289 SCAD and 150 TTS patients were included; 89% were women. TTS patients were older with a higher prevalence of cardiovascular risk factors. Precipitating triggers were more frequent in TTS patients, while emotional triggers and depressive disorders were more common in the SCAD group. Left ventricular ejection fraction was lower in TTS patients, but SCAD patients showed higher cardiac biomarkers. In-hospital events (43.3% vs. 5.2%, P<0.01) occurred more frequently in TTS patients. TTS patients also presented more frequent major adverse events at 12-month (14.7% vs. 7.1%, HR 5.3, 95% CI: 2.4–11.7, P<0.01) and long-term (median 36 vs. 31 months, P=0.41) follow-up (25.8% vs. 9.6%, HR 4.5, 95% CI: 2.5–8.2, P<0.01). Atrial fibrillation was also more frequent in TTS patients. Moreover, TTS patients presented a higher 12-month and long-term mortality (5.6% vs. 0.7%, P=0.01; and 12.6% vs. 0.7%, P<0.01) mainly driven by noncardiovascular deaths. Conclusion Compared to SCAD, TTS patients are older and present more cardiovascular risk factors but less frequent depressive disorder or emotional triggers. TTS patients have a worse in-hospital, mid-term, and long-term prognosis with higher noncardiac mortality than SCAD patients.

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Long-term Risk of Death and Hospitalization in Patients With Heart Failure and Takotsubo Syndrome: Insights From a Nationwide Cohort

Cited by 19 publications

References 30 publications

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

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

Effects of pharmacological interventions on short- and long-term mortality in patients with takotsubo syndrome: a report from the SWEDEHEART registry

Non-atherosclerotic acute cardiac syndromes: spontaneous coronary artery dissection and Takotsubo syndrome. Comparison of long-term clinical outcomes

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