Introduction: The therapeutic management of takotsubo syndrome (TTS) remains controversial, particularly regarding pharmacological treatment after hospital discharge. The prognostic impact of these therapies has not been clearly established. The aim of our study was to assess the clinical variables associated with the occurrence of major adverse cardiovascular events (MACE) and to evaluate the effect of discharge treatment on the follow-up of patients with TTS.
Methods: We included 571 consecutive patients diagnosed with TTS. Clinical, laboratory, and treatment data were collected during hospitalisation and at discharge. Recurrences, all-cause (and cardiovascular) mortality, and the occurrence of MACE (all- cause death, stroke, heart failure events, symptomatic arrhythmias, and acute coronary syndrome) were recorded during a one-year follow-up.
Results: The median age was 73 years (IQR 65.0–80.8), with 87.2% of patients being women. Classical apical forms were observed in 78.3% of cases, secondary forms in 24.4%, and 51.4% were associated with a stressor. During hospitalisation, 13.1% experienced cardiogenic shock. At discharge, 57.7% received antiplatelet therapy, while beta-blockers, ACE inhibitors/ARBs, and statins were prescribed in 58.8%, 57.8%, and 55.2% of cases, respectively. At one-year follow-up, 15.7% of patients developed MACE (8.2% heart failure events, 4.3% arrhythmias, 1.0% ACS, and 0.6% stroke). All-cause mortality at one year was 6.6% (1.6% cardiovascular), with a recurrence rate of 1.0%. Patients who developed MACE were older and had higher rates of hypertension, phenocopies, a history of cancer, and chronic kidney disease. They also had lower haemoglobin levels, higher NT-proBNP values, reduced glomerular filtration rates, and a higher troponin/CK ratio. A greater proportion of physical stressors were observed as triggers, along with more severe heart failure during admission. Conversely, emotional stressors were associated with a better prognosis and a lower incidence of MACE. Regarding pharmacological treatment, the use of beta-blockers and antiplatelet agents was associated with a significant reduction in MACE during one-year follow-up, whereas no prognostic benefit was observed with ACE inhibitors/ARBs or statins.
Conclusion: In patients with TTS, treatment with beta-blockers and antiplatelet agents after hospital discharge was associated with a lower incidence of MACE at one-year follow-up, while the use of ACE inhibitors/ARBs and statins did not show any prognostic benefit.