Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy.
Heart Fail Rev. 2022 May;27(3):857-868. doi: 10.1007/s10741-021-10099-5. Epub 2021 Mar 29.
While the most recent evidence suggests a lack of benefit, antithrombotic therapy is still extensively prescribed in patients with Takotsubo syndrome (TTS). The objective of this study was to determine whether patients with TTS benefit from anti-aggregation, in terms of either short-term or long-term outcomes. A systematic review and meta-analysis was conducted. A comprehensive search of the literature included MEDLINE, Cochrane Library, Clinicaltrials.gov, EU Clinical Trial Register, References, and contact with the authors. Methodological quality assessment and data extraction were systematically performed. The review adhered to the PRISMA framework guidelines. A total of 86 citations were identified, six being eligible for inclusion, for a total of 1997 patients. One of them considered both short-term and long-term outcomes. One reported outcomes during the index event, while the remaining four focused on potential long-term benefits. They were all retrospective cohort studies.Based on our data, the long-term use of antiplatelet therapy (AT) led to a significantly higher incidence of the composite outcome (OR: 1.54; 95% CI 1.09-2.17; p = 0.014) and overall mortality (OR 1.72; 95% CI 1.07-2.77; p = 0.027). The analysis did not show a statistically significant difference in TTS recurrences, stroke/TIA, and MI or CAD worsening with AT compared with no anti-aggregation. The AT in this settings did not show any clear benefit in improving the long-term outcomes, and it may be even detrimental and it may be detrimental. These results warrant further future research and the design of adequately powered randomized controlled trials focusing on the impact of aspirin on the outcomes in patients presenting with TTS.
虽然最近的证据表明抗血栓治疗没有获益，但 Takotsubo 综合征（TTS）患者仍广泛接受抗血栓治疗。本研究旨在确定 TTS 患者在短期和长期结局方面是否受益于抗血小板聚集治疗。进行了系统评价和荟萃分析。系统检索了 MEDLINE、Cochrane 图书馆、Clinicaltrials.gov、EU Clinical Trial Register、参考文献，并与作者联系。系统地进行了方法学质量评估和数据提取。本综述符合 PRISMA 框架指南。共确定了 86 条引文，其中 6 条符合纳入标准，共纳入 1997 例患者。其中一项研究同时考虑了短期和长期结局，一项报告了指数事件期间的结局，其余四项则关注潜在的长期获益。这四项研究均为回顾性队列研究。基于我们的数据，长期使用抗血小板治疗（AT）导致复合结局的发生率显著增加（OR：1.54；95%CI 1.09-2.17；p=0.014）和总死亡率（OR 1.72；95%CI 1.07-2.77；p=0.027）。与无抗血小板聚集治疗相比，AT 并未显示在 TTS 复发、卒中和 TIA 以及 MI 或 CAD 恶化方面具有统计学显著差异。在这种情况下，AT 并没有明显改善长期结局的益处，甚至可能有害。这些结果需要进一步的未来研究和设计适当的、以随机对照试验为基础的研究，重点关注阿司匹林对 TTS 患者结局的影响。
