Serotonin Norepinephrine Reuptake Inhibitor Is Associated With Lower Mortality Among Patients Presenting With Takotsubo Cardiomyopathy.

Background: Serotonin-norepinephrine reuptake inhibitors (SNRIs) inhibit the presynaptic reuptake of serotonin and norepinephrine and are widely used in the treatment of depression and neuropathic pain. We evaluate the impact of SNRIs use on the clinical outcomes of patients presenting with Takotsubo cardiomyopathy (TCM).

Methods: We analyzed data from the TriNetX research network. Patients aged ≥18 years with a principal diagnosis of TCM were identified from January 1, 2003, to December 31, 2023. After excluding patients on SSRIs, stimulants, 5-fluorouracil, capecitabine, gemcitabine, and trastuzumab, patients with myocarditis, pheochromocytoma, acute myocardial infarction, cocaine-related disorders, and opioid-related disorders, were also excluded. The final study population was divided into 2 cohorts: patients on SNRIs and patients not on SNRIs. Propensity score matching was used to adjust for potential confounders. The primary outcome was all-cause mortality, and the secondary outcome was Takotsubo cardiomyopathy-related complications.

Results: A total of 16 853 patients with a diagnosis of TCM were identified, of which 2482 (14.7%) were on SNRIs. The SNRIs cohort were older (mean age 64.1 versus 63.4 years, P=0.012). After propensity score matching, patients on SNRI had lower 7-day mortality (odds ratio [OR], 0.59 [95% CI, 0.41-0.84], P=0.004), cardiac arrest (OR, 0.58 [95% CI, 0.40-0.84], P=0.004), and ventricular fibrillation (OR, 0.496 [95% CI, 0.248-0.995], P=0.044). At 1 year, patients on SNRI had lower mortality (OR, 0.80 [95% CI, 0.67-0.96], P=0.015).

Conclusions: The use of SNRIs among patients presenting with TCM is associated with lower mortality and lower TCM-related complications.