Pereyra Eduardo, Fernández-Rodríguez Diego, González-Sucarrats Silvia, Almendro-Delia Manuel, Martín Agustín, de Miguel Irene Martin, Andrés Mireia, Duran-Cambra Alberto, Sánchez-Grande-Flecha Alejandro, Worner-Diz Fernando, Núñez-Gil Iván J
Department of Cardiology, Hospital Universitario Arnau de Vilanova, Lleida, Spain.
Hospital Universitari Arnau de Vilanova, Lleida, Spain.
Rev Port Cardiol. 2022 Nov;41(11):919-927. doi: 10.1016/j.repc.2021.06.029. Epub 2022 Oct 12.
Endothelial dysfunction and platelet activation have been highlighted as possible mediators in Takotsubo syndrome (TTS). Nevertheless, to date, evidence on the usefulness of antiplatelet therapy in TTS remains controversial. The aim of our study is to evaluate long-term prognosis in TTS patients treated with antiplatelet therapy (APT) at hospitalization discharge.
An ambispective cohort study from the Spanish National Takotsubo Registry database was performed (June 2002 to March 2017). Patients were divided into two groups: those who received APT at hospital discharge (APT cohort) and those who did not (non-APT cohort). Primary endpoint was all-cause death. Secondary endpoints included the composite of recurrence or readmission and a composite of death, recurrence or readmission.
From a total of 741 patients, 728 patients were alive at discharge. Follow-up was performed in 544 patients, who were included in the final analysis: 321 patients (59.0%) in the APT cohort and 223 patients (41.0%) in the non-APT cohort. The APT cohort had a better clinical presentation and received more heart failure and acute coronary syndrome-like therapies (angiotensin converting enzyme inhibitors/angiotensin receptor blockers: 75.1% vs. 51.1%; p<0.001, betablockers: 71.3% vs. 50.7%; p<0.001, statins: 67.9% vs. 33.2%; p<0.001). After adjusting for confounder factors, APT at discharge was a protective factor for all-cause death (adjusted hazard ratio (HR) 0.315, 95% confidence interval (CI): 0.106-0.943; p=0.039) and the composite endpoint of all-cause death, recurrence or readmission (adjusted HR 0.318, 95% CI: 0.164-0.619; p=0.001) at month 25 of follow-up.
Patients with TTS receiving APT at discharge presented better prognosis up to two-years of follow-up compared with their counterparts not receiving APT.
内皮功能障碍和血小板活化已被视为应激性心肌病（TTS）可能的介导因素。然而，迄今为止，抗血小板治疗在TTS中的有效性证据仍存在争议。我们研究的目的是评估在出院时接受抗血小板治疗（APT）的TTS患者的长期预后。
对西班牙国家应激性心肌病注册数据库进行了一项回顾性队列研究（2002年6月至2017年3月）。患者分为两组：出院时接受APT的患者（APT队列）和未接受APT的患者（非APT队列）。主要终点是全因死亡。次要终点包括复发或再入院的复合终点以及死亡、复发或再入院的复合终点。
在总共741例患者中，7:28例患者出院时存活。对544例患者进行了随访，并纳入最终分析：APT队列中有321例患者（59.0%），非APT队列中有223例患者（41.0%）。APT队列的临床表现更好，接受了更多的心力衰竭和急性冠状动脉综合征样治疗（血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂：75.1%对51.1%；p<0.001，β受体阻滞剂：71.3%对50.7%；p<0.001，他汀类药物：67.9%对33.2%；p<0.001）。在对混杂因素进行调整后，出院时的APT是随访第25个月时全因死亡（调整后的风险比（HR）0.315，95%置信区间（CI）：0.106 - 0.943；p = 0.039）以及全因死亡、复发或再入院复合终点（调整后的HR 0.318，95%CI：0.164 - 0.619；p = 0.001）的保护因素。
与未接受APT的患者相比，出院时接受APT的TTS患者在长达两年的随访中表现出更好的预后。
