# Survival benefit of secondary prevention medical therapy in takotsubo cardiomyopathy: a Bayesian network meta-analysis

## TL;DR

This study finds that beta-blockers may reduce mortality in takotsubo cardiomyopathy patients, but other medications show limited benefit.

## Contribution

A Bayesian network meta-analysis comparing the efficacy of secondary prevention medications for takotsubo cardiomyopathy mortality.

## Key findings

- Beta-blockers significantly reduced mortality in takotsubo cardiomyopathy patients compared to control.
- ACE inhibitors/ARBs showed a nonsignificant trend toward mortality reduction.
- Statins and aspirin did not show significant mortality benefit in takotsubo cardiomyopathy patients.

## Abstract

Takotsubo cardiomyopathy (TTC) is a form of transient left ventricular systolic dysfunction without evidence of complicated coronary artery disease. Efficacy of medical therapy in secondary prevention of all-cause mortality is not well established. We performed a systematic review and network meta-analysis to compare survival benefit of secondary prevention medical therapy in patients with TTC.

PubMed, Embase, and Cochrane were searched up to 6 January 2024. Eligible studies included multivariable-adjusted or propensity-matched studies of patients receiving medical therapy with beta-blockers, angiotensin-converting enzyme inhibitors (ACE) or angiotensin receptor blockers (ARBs), 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-analysis was performed. We identified 13 observational studies. Takotsubo cardiomyopathy mortality was reported in 435 (4.7%) out of 9237 patients, across a median follow-up of 2.18 years. Mean age was 69.7 ± 12.5 years, and 7906 patients (90.7%) were females. Beta-blockers were associated with a statistically significant reduction in mortality compared to control [hazard ratio (HR) 0.65, 95% confidence interval (CI) (0.55–0.77)]. ACE inhibitors/ARBs showed a nonsignificant trend towards mortality reduction [HR 0.76, 95% CI (0.54–1.07)]. Statins [HR 0.96, 95% CI (0.77–1.19)] and aspirin [HR 0.87, 95% CI (0.55–1.38)] showed no significant mortality benefit. Bayesian probability ranks favoured beta-blockers as the most effective treatment for TTC mortality prevention.

This review highlights the modest efficacy of secondary prevention medications in the management of TTC, as ACE or ARBs, beta-blockers, aspirin, and statins failed to demonstrate comparative mortality benefit. Randomized controlled trials are needed to confirm efficacy of pharmacotherapy in this vulnerable patient cohort.

Graphical Abstract