Renin angiotensin system inhibitors and outcome in patients with takotsubo syndrome: A propensity score analysis of the GEIST registry

Am Heart J. 2024 Dec:278:127-138. doi: 10.1016/j.ahj.2024.08.019. Epub 2024 Sep 10.

Abstract

Background: Few data are available on long-term drug therapy and its potential prognostic impact after Takotsubo syndrome (TTS). Aim of the study is to evaluate clinical characteristics and long-term outcome of TTS patients on Renin Angiotensin system inhibitors (RASi).

Methods: TTS patients were enrolled in the international multicenter GEIST (GErman Italian Spanish Takotsubo) registry. Median follow-up was 31 (Interquartile range 12-56) months. Comparison of RASi treated vs. untreated patients was performed within the overall population and after 1:1 propensity score matching for age, sex, comorbidities, type of trigger and in-hospital complications.

Registration: clinicaltrials.gov, NCT04361994, https://clinicaltrials.gov/study/NCT04361994 RESULTS: Of the 2453 TTS patients discharged alive, 1683 (68%) received RASi therapy. Patients with RASi were older (age 71 ± 11 vs 69 ± 13 years, P = .01), with higher prevalence of hypertension (74% vs 53%, P < .01) and diabetes (19% v s15%, P = .01), higher admission left ventricular ejection fraction (LVEF) (41 ± 11% vs 39 ± 12%, P < .01) and lower rates of in-hospital complications (18.9% vs 29.6%, P < .01). At multivariable analysis, RASi therapy at discharge was independently associated with lower mortality (HR 0.63, 95% CI 0.45-0.87, P < .01). Survival analysis showed that at long term, patients treated with RASi had lower mortality rates in the overall cohort (log-rank P = .001). However, this benefit was not found among patients treated with RASi in the matched cohort (log-rank P = .168). Potential survival benefit of RASi were present, both in the overall and matched cohort, in 2 subgroups: patients with admission LVEF ≤ 40% (HR 0.54 95% CI 0.38-0.78, P = .001; HR 0.59, 95% CI 0.37-0.95, P = .030) and diabetes (HR 0.41, 95% CI 0.23-0.73, P = .002; HR 0.41, 95% CI 0.21-0.82, P = .011).

Conclusions: Long-term therapy with RASi after a TTS episode was not associated with lower mortality rates at propensity score analysis. However, potential survival benefit can be found among patients with admission LVEF ≤ 40% or diabetes.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Angiotensin Receptor Antagonists / therapeutic use
  • Angiotensin-Converting Enzyme Inhibitors* / therapeutic use
  • Female
  • Follow-Up Studies
  • Humans
  • Hypertension / drug therapy
  • Hypertension / epidemiology
  • Italy / epidemiology
  • Male
  • Middle Aged
  • Prognosis
  • Propensity Score*
  • Registries*
  • Renin-Angiotensin System / drug effects
  • Stroke Volume / physiology
  • Survival Rate / trends
  • Takotsubo Cardiomyopathy* / drug therapy
  • Takotsubo Cardiomyopathy* / mortality
  • Takotsubo Cardiomyopathy* / physiopathology
  • Treatment Outcome
  • Ventricular Function, Left / physiology

Substances

  • Angiotensin-Converting Enzyme Inhibitors
  • Angiotensin Receptor Antagonists

Associated data

  • ClinicalTrials.gov/NCT04361994