Lack of Efficacy of Drug Therapy in Preventing Takotsubo Cardiomyopathy Recurrence: A Meta-analysis

Francesco Santoro, Riccardo Ieva, Francesco Musaico, Armando Ferraretti, Giuseppe Triggiani, Nicola Tarantino, Matteo Di Biase, Natale Daniele Brunetti
2014 Clinical Cardiology  
Efficacy of chronic drug therapy in prevention of stress-induced cardiomyopathy recurrences is not well established. We therefore aimed to evaluate in this meta-analysis whether pharmacological treatment can effectively prevent takotsubo cardiomyopathy (TTC) recurrences, according to available studies. Hypothesis: There is no evidence for preventing TTC recurrence by drug therapy. Methods: After a PubMed search, we conducted a meta-analysis of available studies (clinical nonrandomized
more » ... andomized registries) on efficacy of drug therapy in preventing recurrence of TTC. Results: A total of 23 (4.5%) TTC recurrences occurred in the 511 patients included in the analysis. Seven studies on the effects of β-blockers on prevention of TTC recurrence were evaluated; the odds ratio (OR) was 0.44 and the 95% confidence interval (CI) was 0.15-1.31. In 5 studies on the effects of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, the OR was 0.42 and the 95% CI was 0.08-2.36; in 3 studies on statins, the OR was 0.74 and the 95% CI was 0.07-7.3; and in 4 studies on aspirin, the OR was 0.33 with a 95% CI of 0.05-2.17 (P value not significant in all cases). Conclusions: A meta-analysis of the efficacy of different medications through the clinical TTC registries available showed no clinical evidence for a standard drug treatment in the chronic management of TTC. β-Blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, statins, and aspirin do not seem to significantly reduce recurrences of TTC. Randomized, adequately powered studies are needed to further assess this issue. Figure 2. (A) Effect of β-blockade on recurrence of TTC. (B) Effect of ACEI/ARB blockade on recurrence of TTC. (C) Effect of statins on recurrence of TTC. (D) Effect of aspirin on recurrence of TTC. For each study, the size of the box is proportional to the sample size, and the lines denote the 95% CI. For the combined result, the ends of the diamond shape denote the 95% CI. Abbreviations: ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker; CI, confidence interval; DF, degrees of freedom; Q, Cochran's Q; TTC, takotsubo cardiomyopathy. 436
doi:10.1002/clc.22280 pmid:24700369 fatcat:ze4ka22offdc7f2o5u4zovuow4