Introduction: The prognosis following hospital discharge in patients with takotsubo syndrome (TTS) is defined by the risk of recurrence, symptoms of heart failure (HF), and increased mortality. Recurrence rates of up to 12% at 4 years have been described in certain studies. The prevention of recurrences through long-term treatment with ACE inhibitors/ARBs, beta-blockers, antiplatelet agents or statins remains controversial, with mixed results across different studies. The aim of this study was to compare the clinical profile of patients who experienced recurrences after an initial episode of TTS and to evaluate the association between discharge pharmacological treatment and recurrence prevention.
Methods: A total of 571 TTS consecutive cases. Clinical, analytical, and treatment data were collected during hospitalisation and at discharge. Recurrences were recorded during follow-up at 1 and 2 years, and variables associated with 2-year recurrences were evaluated.
Results: The median age was 73 years (IQR 65.0–80.8), with 87.2% of patients being women. Classical apical forms were seen in 78.3%, secondary forms in 24.4%, and 51.4% were associated with a stressor. At admission, 33.6% of patients presented with Killip class >1. At discharge, 58.8% of patients received beta-blockers, 57.7% ACE inhibitors/ARBs, 57.6% antiplatelet therapy, and 55.1% statins. A total of 18.7% were prescribed all four pharmacological groups. Recurrence rates were 1.0% at 1 year (5 patients), 3.0% at 2 years (15 patients). Among patients with recurrences, there was a higher prevalence of a history of psychiatric disorders and a non-significant trend toward a higher proportion of males, a history of coronary artery disease, and lower glomerular filtration rates. No significant differences were observed between groups regarding stressors, phenocopies, classical versus atypical forms, LVEF on admission, NT-proBNP levels, troponin/CK ratio, or Killip class on admission. None of the pharmacological groups (beta-blockers, ACE inhibitors/ARBs, statins, or antiplatelets) were associated with a lower recurrence rate at 2 years. A non-significant trend towards a higher recurrence rate was observed in patients treated with beta-blockers.
Conclusion: The use of antiplatelet agents, beta-blockers, ACE inhibitors/ARBs, and statins was not associated with a reduced recurrence rate following hospital discharge in patients with TTS during a 2-year follow-up. These findings highlight the need to identify effective therapeutic strategies to prevent recurrent episodes in this patient population.