Am J Cardiol. 2026 May 16:S0002-9149(26)00342-5. doi: 10.1016/j.amjcard.2026.05.012. Online ahead of print.
ABSTRACT
BACKGROUND: Pharmacologic management after Takotsubo syndrome remains empirical.
OBJECTIVES: We evaluated whether early sodium-glucose cotransporter-2 inhibitor initiation after Takotsubo syndrome was associated with clinical outcomes in a large real-world cohort.
METHODS: Using the TriNetX U.S. Collaborative Network, we identified adults with incident Takotsubo syndrome from 2015 through 2025. Patients initiated on a sodium-glucose cotransporter-2 inhibitor within 14 days were propensity matched 1:1 to patients without early sodium-glucose cotransporter-2 inhibitor use. Follow-up for time-to-event analyses began on day 14. The primary outcome was all-cause mortality. Secondary outcomes were heart failure hospitalization, cardiogenic shock, cardiac arrest, and major adverse cardiovascular events.
RESULTS: Among 54,701 patients with Takotsubo syndrome, 1,803 matched pairs were analyzed. Early sodium-glucose cotransporter-2 inhibitor use was associated with lower all-cause mortality (8.1% vs 13.6%; hazard ratio 0.71, 95% confidence interval 0.58 to 0.87; p = 0.001). Associations were not significant for heart failure hospitalization, cardiogenic shock, cardiac arrest, or major adverse cardiovascular events. Mortality findings were directionally consistent in sensitivity analyses excluding patients with coronavirus disease 2019 and, separately, diabetes mellitus.
CONCLUSIONS: In this observational landmark analysis, early sodium-glucose cotransporter-2 inhibitor use after Takotsubo syndrome was associated with lower all-cause mortality but not lower cardiovascular event rates.
PMID:42144123 | DOI:10.1016/j.amjcard.2026.05.012