Prognostic impact 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. Although initially considered a benign condition, recent studies have demonstrated a significant risk of acute phase complications and a mortality rate between 1-8%. 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 January 6, 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 9735 patients. Mean age was 70.2 ± 4 years and 8858 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 Takotsubo cardiomyopathy with the use of secondary prevention medical therapies, including beta-blockers, RAAS inhibitors, aspirin, and statins