Prognostic value of secondary prevention medical therapy in patients with Takotsubo cardiomyopathy: A Bayesian network meta-analysis.

Abstract

Background: Takotsubo cardiomyopathy (TTC) is a form of transient left ventricular systolic dysfunction without evidence of complicated coronary artery disease. Efficacy of medical therapy in secondary prevention of all-cause mortality and TTC recurrence is not well established. We performed a systematic review and network meta-analysis to evaluate prognostic impact of secondary prevention medical therapy in patients with TTC. Methods: PubMed, MEDLINE, EMBASE, CENTRAL, and Web of Science were searched up to 6 January 2024. Eligible studies included multivariable-adjusted or propensity matched studies of patients receiving medical therapy with B-blockers (BB), renin–angiotensin–aldosterone system (RAAS) inhibitors, aspirin and statins after an index presentation with TTC. The primary outcome was all-cause mortality at any time point. Secondary outcome was TTC recurrence. Random-effect hierarchical Bayesian meta-analyses was performed. Results: We identified 15 observational studies. TTC mortality was reported in 435 (4.4%) out of 9,735 patients. Mean age was 70.2±4 years and 8,858 patients (91.5%) were females. There were no differences in all-cause mortality when comparing BB versus control (OR 0.83; 95% CI 0.47 to 1.47, p=0.52); BB versus RAAS inhibitors (OR 1.03; 95% CI 0.61–1.63), BB versus aspirin (OR 1.02; 95% CI 0.471–2.25) and BB versus statins (OR 0.871; 95% 0.432–1.75). No significant differences were also observed for TTC recurrence. Conclusion: This network meta-analysis found no significant difference in all-cause mortality or recurrence rates in TTC with the use of secondary prevention medical therapies, including beta-blockers, RAAS inhibitors, aspirin, and statins.