SPC365

Beta-blockers and antiplatelet therapy in Takotsubo Syndrome – To do or not to do?

Session: Comunicações Orais - Sessão 26 - Doenças do Miocárdio
Speaker: Pedro Rocha Carvalho

Congress: CPC 2023
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 17. Myocardial Disease
Subtheme: 17.7 Myocardial Disease - Other
Session Type: Comunicações Orais
FP Number: ---
Authors: Pedro Rocha Carvalho; Isabel Moreira; Marta Catarina Bernardo; Catarina Carvalho; Catarina Ferreira; Fernando Gonçalves; Pedro Magalhães; José Paulo Fontes; Ilídio Moreira
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:black">Introduction:</span></span></strong> <span style="background-color:white"><span style="color:#212121">Sympathetic nerve stimulation and catecholamine storm are the main players in the pathogenesis of </span></span><span style="background-color:white"><span style="color:black">Takotsubo Syndrome (TTS), however, the impact of beta-blockers (BB) remains uncertain. Conversely, despite recent evidence suggesting a lack of benefit, antiplatelet therapy is still extensively prescribed in patients with TTS. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:black">Purpose:</span></span></strong><span style="background-color:white"><span style="color:black"> To study if BB and antiplatelet therapy use after discharge in patients with TTS are associated with lower long-term major cardiovascular events. </span></span></span></span></p>

<p style="text-align:justify"><br />
<span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><strong><span style="background-color:white">Methods: </span></strong><span style="background-color:white">Retrospective study with patients discharged with the diagnosis of TTS in a single center from January/2013 to November/2022</span></span>. <span style="background-color:white"><span style="color:black">The primary outcome was a composite of cardiovascular mortality, heart failure hospitalization, stroke, and TTS recurrence (MACCE).&nbsp;&nbsp;&nbsp; </span></span></span></span></p>

<p style="text-align:justify"><br />
<span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><strong><span style="background-color:white">Results: </span></strong><span style="background-color:white">A total of</span><strong> </strong></span><span style="background-color:white"><span style="color:#212529">103 patients were included in this study (85,7% females; mean age 71&plusmn;12 years old), 84,8% presenting with chest pain and 41,2% presenting with ST-segment elevation on electrocardiogram. During hospitalization, 37 had heart failure, 9 had a cardiogenic shock, 4 had left ventricular outflow tract obstruction, 7 patients needed ionotropic support, 14 needed mechanical ventilation and 4 died.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:#212529">Compared with the other without BB, patients discharged on BB (69,9%) had similar age (69,0&plusmn;12 vs 73&plusmn;12 years, p=0,093), cardiovascular risk factors, ST-segment elevation at admission (36,6% vs 53,8%, p=0,14), pro-BNP levels at admission [2800</span></span> <span style="color:black">[IQR 741;6039 </span>mg/dl] vs 3996 [IQR <span style="color:black">1224;10031 </span>mg/dl], p = 0,23] and peak T troponin (0,4 IQR <span style="color:black">[0,22;0,70]</span>) vs 0,54 IQR <span style="color:black">[0,30;1,5]</span>),p=0,10. There was no difference in left ventricular ejection fraction on admission (39,5% vs 39%, p= 0,74) and at discharge (54% vs 54 %, p=0,85). However, there was a higher percentage of men in the group of patients without BB therapy (8,3% vs 30,8%, p=0,005).</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Antithrombotic therapy given during hospitalization and on discharge was similar in patients with and without beta-blocker prescription.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">During a median follow-up of 41 months [14;59<span style="font-size:12.0pt">],</span> 24 patients (27,3%) <span style="background-color:white"><span style="color:black">experienced a MACCE event</span></span>. <span style="background-color:white"><span style="color:#212121">On adjusted Cox regression analysis, patients under BB therapy showed a significantly lower risk for MACCE events (adjusted HR: 0.338; 95% CI: 0.135 to 0.849), however, this was not true for antiplatelet therapy (HR: 0.733; 95% CI: 0.315 to 0.1,704, p=0,477).</span></span></span></span></p>

<p style="text-align:justify"><br />
<span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black"><strong><span style="background-color:white">Conclusion:</span></strong>&nbsp;</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:black">In this study, patients </span></span><span style="background-color:white"><span style="color:#212529">discharged on beta-blockers had a significant risk reduction of </span></span><span style="background-color:white"><span style="color:black">cardiovascular mortality, heart failure hospitalizations, stroke or takotsubo syndrome recurrence. </span></span><span style="background-color:white"><span style="color:#212529">A</span></span><span style="background-color:white"><span style="color:#212121">ntiplatelet therapy, however, failed to show a similar risk reduction benefit.</span></span></span></span></p>