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Meta-Analysis
. 2022 May;27(3):857-868.
doi: 10.1007/s10741-021-10099-5. Epub 2021 Mar 29.

Prognostic impact of antiplatelet therapy in Takotsubo syndrome: a systematic review and meta-analysis of the literature

Francesca Rizzetto #  1 , Micaela Lia #  1 , Maddalena Widmann #  1 , Domenico Tavella  1 , Luisa Zanolla  1 , Michele Pighi  2 , Valeria Ferrero  1 , Flavio Luciano Ribichini  1
Affiliations
Meta-Analysis

Prognostic impact of antiplatelet therapy in Takotsubo syndrome: a systematic review and meta-analysis of the literature

Francesca Rizzetto et al. Heart Fail Rev. 2022 May.

Abstract

While the most recent evidence suggests a lack of benefit, antithrombotic therapy is still extensively prescribed in patients with Takotsubo syndrome (TTS). The objective of this study was to determine whether patients with TTS benefit from anti-aggregation, in terms of either short-term or long-term outcomes. A systematic review and meta-analysis was conducted. A comprehensive search of the literature included MEDLINE, Cochrane Library, Clinicaltrials.gov, EU Clinical Trial Register, References, and contact with the authors. Methodological quality assessment and data extraction were systematically performed. The review adhered to the PRISMA framework guidelines. A total of 86 citations were identified, six being eligible for inclusion, for a total of 1997 patients. One of them considered both short-term and long-term outcomes. One reported outcomes during the index event, while the remaining four focused on potential long-term benefits. They were all retrospective cohort studies.Based on our data, the long-term use of antiplatelet therapy (AT) led to a significantly higher incidence of the composite outcome (OR: 1.54; 95% CI 1.09-2.17; p = 0.014) and overall mortality (OR 1.72; 95% CI 1.07-2.77; p = 0.027). The analysis did not show a statistically significant difference in TTS recurrences, stroke/TIA, and MI or CAD worsening with AT compared with no anti-aggregation. The AT in this settings did not show any clear benefit in improving the long-term outcomes, and it may be even detrimental and it may be detrimental. These results warrant further future research and the design of adequately powered randomized controlled trials focusing on the impact of aspirin on the outcomes in patients presenting with TTS.

Keywords: Antiplatelet; Antithrombotic; Aspirin; Broken heart syndrome; Stress cardiomyopathy; Takotsubo.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study flow chart which illustrates the study selection process in accordance with the PRISMA statement. PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Fig. 2
Fig. 2
Composite outcome AT: antiplatelet therapy; OR: odds ratio; CI: confidence interval
Fig. 3
Fig. 3
All-cause mortality AT: antiplatelet therapy; OR: odds ratio; CI: confidence interval
Fig. 4
Fig. 4
Recurrence of events AT: antiplatelet therapy; OR: odds ratio; CI: confidence interval
Fig. 5
Fig. 5
Stroke or TIA AT: antiplatelet therapy; OR: odds ratio; CI: confidence interval
Fig. 6
Fig. 6
MI or CAD progression AT: antiplatelet therapy; OR: odds ratio; CI: confidence interval
See this image and copyright information in PMC

References

    1. Scantlebury DC, Prasad A. Diagnosis of Takotsubo cardiomyopathy – Mayo Clinic criteria –. Circ J. 2014;78(9):2129–2139. doi: 10.1253/circj.CJ-14-0859. - DOI - PubMed
    1. Marafioti V, Benfari G. Takotsubo syndrome: a neurocardiac syndrome inside the autonomic nervous system. Heart Fail Rev. 2019;24(2):227. doi: 10.1007/s10741-018-9748-2. - DOI - PubMed
    1. Mugnai G, Pasqualin G, Benfari G, Bertagnolli L, Mugnai F, Vassanelli F, Marchese G, Pesarini G, Menegatti G (2015) Acute electrocardiographic differences between Takotsubo cardiomyopathy and anterior ST elevation myocardial infarction. J Electrocardiol 48(1):79–85 - PubMed
    1. Pelliccia F, Kaski JC, Crea F, Camici PG. Pathophysiology of Takotsubo syndrome. Circulation. 2017;135:2426–2441. doi: 10.1161/CIRCULATIONAHA.116.027121. - DOI - PubMed
    1. Basso C, Thiene G. The pathophysiology of myocardial reperfusion: a pathologist’s perspective. Heart. 2006;92:1559–1562. doi: 10.1136/hrt.2005.086959. - DOI - PMC - PubMed

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