Antiplatelet therapy in Takotsubo cardiomyopathy: does it improve cardiovascular outcomes during index event?

Andre Dias, Emiliana Franco, Nikoloz Koshkelashvili, Vikas Bhalla, Gregg S. Pressman, Kathy Hebert, Vincent M. Figueredo

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Plasma catecholamines may play an important role in Takotsubo cardiomyopathy (TCM) pathophysiology. Patients with disproportionately high catecholamine responses to stressful events are prone to worse clinical outcomes. Catecholamines stimulate platelet activation and, therefore, may determine the clinical presentation and outcomes of TCM. We conducted a retrospective, descriptive study TCM patients admitted between 2003 and 2013 to Einstein Medical Center, Philadelphia, PA, USA and Danbury Hospital, Danbury, CT, USA. A total of 206 patients met Modified Mayo TCM criteria. Using a multiple logistic model, we tested whether aspirin, dual antiplatelet therapy (DAPT) aspirin + clopidogrel, beta blocker, statin, or ACE inhibitor use were independent predictors of major adverse cardiovascular events (MACE) during the index hospitalization. MACE was defined as in-hospital heart failure, in-hospital death, stroke or respiratory failure requiring mechanical ventilation. Incidence of in-hospital heart failure was 26.7 %, in-hospital death was 7.3 %, stroke was 7.3 % and MACE was 42.3 %. In a multiple logistic regression model (adjusted for gender, race, age, physical stressor, hypertension, diabetes, hyperlipidemia, smoking history, body mass index, initial left ventricular ejection fraction, single antiplatelet therapy, DAPT, beta blocker, statin, and ACE inhibitor) aspirin and DAPT at the time of hospitalization were independent predictors of a lower incidence of MACE during the index hospitalization (aspirin: OR 0.4, 95 % CI (0.16–0.9), P = 0.04; DAPT: OR 0.23; 95 % CI (0.1–0.55); P < 0.01. Physical stressor itself was also found to be an independent predictor of worse MACE: OR 5.1; 95 % CI (2.4–11.5); P < 0.01. In our study, aspirin and DAPT were independent predictors of a lower incidence of MACE during hospitalization for TCM. Prospective clinical trials are needed to confirm the findings of this study.

Original languageEnglish (US)
JournalHeart and Vessels
DOIs
StateAccepted/In press - Aug 13 2015
Externally publishedYes

Fingerprint

Takotsubo Cardiomyopathy
Aspirin
Hospitalization
Catecholamines
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Logistic Models
clopidogrel
Angiotensin-Converting Enzyme Inhibitors
Incidence
Therapeutics
Heart Failure
Stroke
Platelet Activation
Hyperlipidemias
Artificial Respiration
Respiratory Insufficiency
Stroke Volume
Body Mass Index
Retrospective Studies
Smoking

Keywords

  • Antiplatelets
  • Cardiovascular outcomes
  • Takotsubo cardiomyopathy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Dias, A., Franco, E., Koshkelashvili, N., Bhalla, V., Pressman, G. S., Hebert, K., & Figueredo, V. M. (Accepted/In press). Antiplatelet therapy in Takotsubo cardiomyopathy: does it improve cardiovascular outcomes during index event? Heart and Vessels. https://doi.org/10.1007/s00380-015-0729-2

Antiplatelet therapy in Takotsubo cardiomyopathy : does it improve cardiovascular outcomes during index event? / Dias, Andre; Franco, Emiliana; Koshkelashvili, Nikoloz; Bhalla, Vikas; Pressman, Gregg S.; Hebert, Kathy; Figueredo, Vincent M.

In: Heart and Vessels, 13.08.2015.

Research output: Contribution to journalArticle

Dias, Andre ; Franco, Emiliana ; Koshkelashvili, Nikoloz ; Bhalla, Vikas ; Pressman, Gregg S. ; Hebert, Kathy ; Figueredo, Vincent M. / Antiplatelet therapy in Takotsubo cardiomyopathy : does it improve cardiovascular outcomes during index event?. In: Heart and Vessels. 2015.
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abstract = "Plasma catecholamines may play an important role in Takotsubo cardiomyopathy (TCM) pathophysiology. Patients with disproportionately high catecholamine responses to stressful events are prone to worse clinical outcomes. Catecholamines stimulate platelet activation and, therefore, may determine the clinical presentation and outcomes of TCM. We conducted a retrospective, descriptive study TCM patients admitted between 2003 and 2013 to Einstein Medical Center, Philadelphia, PA, USA and Danbury Hospital, Danbury, CT, USA. A total of 206 patients met Modified Mayo TCM criteria. Using a multiple logistic model, we tested whether aspirin, dual antiplatelet therapy (DAPT) aspirin + clopidogrel, beta blocker, statin, or ACE inhibitor use were independent predictors of major adverse cardiovascular events (MACE) during the index hospitalization. MACE was defined as in-hospital heart failure, in-hospital death, stroke or respiratory failure requiring mechanical ventilation. Incidence of in-hospital heart failure was 26.7 {\%}, in-hospital death was 7.3 {\%}, stroke was 7.3 {\%} and MACE was 42.3 {\%}. In a multiple logistic regression model (adjusted for gender, race, age, physical stressor, hypertension, diabetes, hyperlipidemia, smoking history, body mass index, initial left ventricular ejection fraction, single antiplatelet therapy, DAPT, beta blocker, statin, and ACE inhibitor) aspirin and DAPT at the time of hospitalization were independent predictors of a lower incidence of MACE during the index hospitalization (aspirin: OR 0.4, 95 {\%} CI (0.16–0.9), P = 0.04; DAPT: OR 0.23; 95 {\%} CI (0.1–0.55); P < 0.01. Physical stressor itself was also found to be an independent predictor of worse MACE: OR 5.1; 95 {\%} CI (2.4–11.5); P < 0.01. In our study, aspirin and DAPT were independent predictors of a lower incidence of MACE during hospitalization for TCM. Prospective clinical trials are needed to confirm the findings of this study.",
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