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

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). 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. 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). 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.

Santoro F ，Stiermaier T ，Núñez Gil IJ ，El-Battrawy I ，Pätz T ，Cacciotti L ，Guerra F ，Novo G ，Musumeci B ，Volpe M ，Mariano E ，Caldarola P ，Montisci R ，Ragnatela I ，Cetera R ，Vazirani R ，Lluch C ，Uribarri A ，Corbi-Pascual M ，Conty Cardona DA ，Akin I ，Barbato E ，Thiele H ，Brunetti ND ，Eitel I ，Arcari L ... -  《-》

Assessment of the German and Italian Stress Cardiomyopathy Score for Risk Stratification for In-hospital Complications in Patients With Takotsubo Syndrome.

Santoro F ，Núñez Gil IJ ，Stiermaier T ，El-Battrawy I ，Guerra F ，Novo G ，Guastafierro F ，Tarantino N ，Novo S ，Mariano E ，Romeo F ，Romeo F ，Capucci A ，Bahlmann E ，Zingaro M ，Cannone M ，Caldarola P ，Marchetti MF ，Montisci R ，Meloni L ，Thiele H ，Di Biase M ，Almendro-Delia M ，Sionis A ，Akin I ，Eitel I ，Brunetti ND ... -  《-》

Impact of renin-angiotensin system blockade on the prognosis of acute coronary syndrome based on left ventricular ejection fraction.

For patients with acute coronary syndrome (ACS) treated with percutaneous coronary intervention (PCI), it is unclear whether angiotensin-converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) are associated with reduced mortality, particularly with preserved left ventricular ejection fraction (LVEF). The goal of this study was to determine the association between ACEI/ARB and mortality in ACS patients undergoing PCI, with and without reduced LVEF. Data from the BleeMACS registry were used. The endpoint was 1-year all-cause mortality. The prognostic value of ACEI/ARB was tested after weighting by survival-time inverse probability and after adjustment by Cox regression, propensity score, and instrumental variable analysis. Among 15 401 ACS patients who underwent PCI, ACEI/ARB were prescribed in 75.2%. There were 569 deaths (3.7%) during the first year after hospital discharge. After multivariable adjustment, ACEI/ARB were associated with lower 1-year mortality, ≤ 40% (HR, 0.62; 95%CI, 0.43-0.90; P=.012). The relative risk reduction of ACEI/ARB in mortality was 46.1% in patients with LVEF ≤ 40%, and 15.7% in patients with LVEF> 40% (P value for treatment-by-LVEF interaction=.008). For patients with LVEF> 40%, ACEI/ARB was associated with lower mortality only in ST-segment elevation myocardial infarction (HR, 0.44; 95%CI, 0.21-0.93; P=.031). The benefit of ACEI/ARB in decreasing mortality after an ACS in patients undergoing PCI is concentrated in patients with LVEF ≤ 40%, and in those with LVEF> 40% and ST-segment elevation myocardial infarction. In non-ST-segment elevation-ACS patients with LVEF> 40%, further studies are needed to assess the prognostic impact of ACEI/ARB.

Raposeiras-Roubín S ，Abu-Assi E ，Cespón-Fernández M ，Ibáñez B ，García-Ruiz JM ，D'Ascenzo F ，Simao Henriques JP ，Saucedo J ，Caneiro-Queija B ，Cobas-Paz R ，Muñoz-Pousa I ，Wilton SB ，González Juanatey JR ，Kikkert WJ ，Núñez-Gil I ，Ariza-Solé A ，Song X ，Alexopoulos D ，Liebetrau C ，Kawaji T ，Gaita F ，Huczek Z ，Nie SP ，Yan Y ，Fujii T ，Correia L ，Kawashiri MA ，Kedev S ，Southern D ，Alfonso E ，Terol B ，Garay A ，Zhang D ，Chen Y ，Xanthopoulou I ，Osman N ，Möllmann H ，Shiomi H ，Giordana F ，Kowara M ，Filipiak K ，Wang X ，Fan JY ，Ikari Y ，Nakahayshi T ，Sakata K ，Yamagishi M ，Kalpak O ，Íñiguez-Romo A ... -  《-》

Statin therapy and outcome in Takotsubo syndrome patients: Results from the multicenter international GEIST registry.

Novo G ，Arcari L ，Stiermaier T ，Alaimo C ，El-Battrawy I ，Cacciotti L ，Guerra F ，Musumeci B ，Mariano E ，Parisi G ，Montisci R ，Vazirani R ，Perez Castellanos A ，Uribarri A ，Corbi-Pascual M ，Salamanca J ，Akin I ，Thiele H ，Brunetti ND ，Eitel I ，Núñez Gil IJ ，Santoro F ... -  《-》

Long-term outcome in patients with Takotsubo syndrome presenting with severely reduced left ventricular ejection fraction.

To evaluate the long-term outcome of patients with Takotsubo syndrome (TTS) and severely reduced left ventricular ejection fraction (LVEF ≤ 35%) at presentation. The study population included 326 patients (mean age 69.5 ± 10.7 years, 28 male) with TTS enrolled in the Takotsubo Italian Network, divided into two groups according to LVEF (≤ 35%, n = 131; > 35%, n = 195), as assessed by transthoracic echocardiography at hospital admission. In-hospital events were recorded in both groups. At long-term follow-up (median 26.5 months, interquartile range 18-33), composite major adverse cardiac events (MACE: cardiac death, acute myocardial infarction, heart failure, and TTS recurrence) and rehospitalization were investigated. Compared to patients with LVEF > 35%, patients with LVEF ≤ 35% were older (71.2 ± 10.8 vs. 68.4 ± 10.6 years; P = 0.026) and experienced more frequently cardiogenic shock (16% vs. 4.6%; P < 0.001), acute heart failure (28.2% vs. 12.8%; P = 0.001), and intra-aortic balloon pump support (11.5% vs. 2.6%; P = 0.001) in the acute phase. At long-term follow-up, higher rates of composite MACE (25.2% vs. 10.8%; P = 0.001) and rehospitalization for cardiac causes (26% vs. 13.3%; P = 0.004) were observed in these patients. LVEF ≤ 35% at admission [hazard ratio (HR) 2.184, 95% confidence interval (CI) 1.231-3.872; P = 0.008] and age (HR 1.041, 95% CI 1.011-1.073; P = 0.006) were independent predictors of MACE. Patients with LVEF ≤ 35% also had a significant lower freedom from composite MACE during long-term follow-up (χ2 = 11.551, P = 0.001). Left ventricular ejection fraction ≤ 35% at presentation is a key parameter to identify TTS patients at higher risk not only in the acute phase but also at long-term follow-up.

Citro R ，Radano I ，Parodi G ，Di Vece D ，Zito C ，Novo G ，Provenza G ，Bellino M ，Prota C ，Silverio A ，Antonini-Canterin F ，Rigo F ，Vriz O ，Galasso G ，Bossone E ，Salerno-Uriarte J ，Piscione F ... -  《-》