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. 2024 Feb 28;3(2):100797.
doi: 10.1016/j.jacadv.2023.100797.

Cardiovascular and Noncardiovascular Prescribing and Mortality After Takotsubo Comparison With Myocardial Infarction and General Population

Amelia E Rudd  1 , Graham Horgan  2 , Hilal Khan  1 , David T Gamble  1 , Jim McGowan  3 , Arvind Sood  4 , Ross McGeoch  4 , John Irving  5 , Jonathan Watt  6 , Stephen J Leslie  6 , Mark Petrie  7 , Chim Lang  5 , Nicholas L Mills  8   9 , David E Newby  9 , Dana K Dawson  1
Affiliations

Cardiovascular and Noncardiovascular Prescribing and Mortality After Takotsubo Comparison With Myocardial Infarction and General Population

Amelia E Rudd et al. JACC Adv. .

Abstract

Background: Takotsubo syndrome is an increasingly common cardiac emergency with no known evidence-based treatment.

Objectives: The purpose of this study was to investigate cardiovascular mortality and medication use after takotsubo syndrome.

Methods: In a case-control study, all patients with takotsubo syndrome in Scotland between 2010 and 2017 (n = 620) were age, sex, and geographically matched to individuals in the general population (1:4, n = 2,480) and contemporaneous patients with acute myocardial infarction (1:1, n = 620). Electronic health record data linkage of mortality outcomes and drug prescribing were analyzed using Cox proportional hazard regression models.

Results: Of the 3,720 study participants (mean age, 66 years; 91% women), 153 (25%) patients with takotsubo syndrome died over the median of 5.5 years follow-up. This exceeded mortality rates in the general population (N = 374 [15%]; HR: 1.78 [95% CI: 1.48-2.15], P < 0.0001), especially for cardiovascular (HR: 2.47 [95% CI: 1.81-3.39], P < 0.001) but also noncardiovascular (HR: 1.48 [95% CI: 1.16-1.87], P = 0.002) deaths. Mortality rates were lower for patients with takotsubo syndrome than those with myocardial infarction (31%, 195/620; HR: 0.76 [95% CI: 0.62-0.94], P = 0.012), which was attributable to lower rates of cardiovascular (HR: 0.61 [95% CI: 0.44-0.84], P = 0.002) but not non-cardiovascular (HR: 0.92 [95% CI: 0.69-1.23], P = 0.59) deaths. Despite comparable medications use, cardiovascular therapies were consistently associated with better survival in patients with myocardial infarction but not in those with takotsubo syndrome. Diuretic (P = 0.01), anti-inflammatory (P = 0.002), and psychotropic (P < 0.001) therapies were all associated with worse outcomes in patients with takotsubo syndrome.

Conclusions: In patients with takotsubo syndrome, cardiovascular mortality is the leading cause of death, and this is not associated with cardiovascular therapy use.

Keywords: cardiovascular; electronic data linkage; medication; mortality; myocardial infarction; takotsubo.

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Conflict of interest statement

Dr Dawson has received Chief Scientist Office Scotland award CGA-16-4 and the BHF Research Training Fellowship (FS/RTF/20/30009, for Ms Amelia Rudd). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
All-Cause Mortality (A) All-cause mortality in patients with takotsubo syndrome (red), acute myocardial infarction (green) and the general population (black). (B) Early (30-day) (left panel) and landmark post 30 days (right panel) all-cause mortality. Specific causes of mortality: cardiovascular (C), noncardiovascular (D).
Figure 2
Figure 2
Cardiovascular and Noncardiovascular Medications and Mortality Patients with takotsubo syndrome (left panels) or myocardial infarction (right panels) mortality according to cardiovascular or noncardiovascular medication prescribed during follow-up in a binary analysis (A) or when medication was prescribed for the majority (at least 50%) of their follow-up duration (B). ACE = angiotensin-converting enzyme; ARB = angiotensin receptor blocker; HRT = hormone replacement therapy; NSAID = nonsteroidal anti-inflammatory drugs.
Central Illustration
Central Illustration
Cardiovascular and Noncardiovascular Prescribing and Mortality Outcomes After Takotsubo Syndrome The first report from the Scottish Takotsubo Registry, a retrospective case-control investigation reporting on the cardiovascular and noncardiovascular prescribing and mortality outcomes after acute takotsubo syndrome compared to acute myocardial infarction and general Scottish population controls.
See this image and copyright information in PMC

Comment in

References

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