{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T19:47:47Z","timestamp":1790279267730,"version":"4.1.0"},"reference-count":47,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T00:00:00Z","timestamp":1744761600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Takotsubo cardiomyopathy (TTC) is a form of transient left ventricular systolic dysfunction without evidence of complicated coronary artery disease. Efficacy of medical therapy in secondary prevention of all-cause mortality is not well established. We performed a systematic review and network meta-analysis to compare survival benefit of secondary prevention medical therapy in patients with TTC.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>PubMed, Embase, and Cochrane were searched up to 6 January 2024. Eligible studies included multivariable-adjusted or propensity-matched studies of patients receiving medical therapy with beta-blockers, angiotensin-converting enzyme inhibitors (ACE) or angiotensin receptor blockers (ARBs), aspirin, and statins after an index presentation with TTC. The primary outcome was all-cause mortality at any time point. Secondary outcome was TTC recurrence. Random-effect hierarchical Bayesian meta-analysis was performed. We identified 13 observational studies. Takotsubo cardiomyopathy mortality was reported in 435 (4.7%) out of 9237 patients, across a median follow-up of 2.18 years. Mean age was 69.7 \u00b1 12.5 years, and 7906 patients (90.7%) were females. Beta-blockers were associated with a statistically significant reduction in mortality compared to control [hazard ratio (HR) 0.65, 95% confidence interval (CI) (0.55\u20130.77)]. ACE inhibitors\/ARBs showed a nonsignificant trend towards mortality reduction [HR 0.76, 95% CI (0.54\u20131.07)]. Statins [HR 0.96, 95% CI (0.77\u20131.19)] and aspirin [HR 0.87, 95% CI (0.55\u20131.38)] showed no significant mortality benefit. Bayesian probability ranks favoured beta-blockers as the most effective treatment for TTC mortality prevention.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>This review highlights the modest efficacy of secondary prevention medications in the management of TTC, as ACE or ARBs, beta-blockers, aspirin, and statins failed to demonstrate comparative mortality benefit. Randomized controlled trials are needed to confirm efficacy of pharmacotherapy in this vulnerable patient cohort.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjopen\/oeaf040","type":"journal-article","created":{"date-parts":[[2025,4,16]],"date-time":"2025-04-16T18:44:17Z","timestamp":1744829057000},"source":"Crossref","is-referenced-by-count":4,"title":["Survival benefit of secondary prevention medical therapy in takotsubo cardiomyopathy: a Bayesian network meta-analysis"],"prefix":"10.1093","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-4056-7097","authenticated-orcid":false,"given":"Daud","family":"Mutahar","sequence":"first","affiliation":[{"name":"Faculty of Health Sciences and Medicine, Bond University, 14 University Drive, Robina, QLD 4216 ,","place":["Australia"]},{"name":"Department of Cardiology, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, QLD 4215 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4513-9601","authenticated-orcid":false,"given":"Ammar","family":"Zaka","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, QLD 4215 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5130-8628","authenticated-orcid":false,"given":"Stephen","family":"Bacchi","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7939-3489","authenticated-orcid":false,"given":"Brandon","family":"Stretton","sequence":"additional","affiliation":[{"name":"Royal Adelaide Hospital , Port Rd, Adelaide, SA 5000 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