AIMS: The aim of the present study was to investigate the impact of aspirin on prognosis in takotsubo syndrome (TTS). METHODS AND RESULTS: Patients from the International Takotsubo (InterTAK) Registry were categorized into two groups based on aspirin prescription at discharge. A comparison of clinical outcomes between groups was performed using an adjusted analysis with propensity score (PS) stratification; results from the unadjusted analysis were also reported to note the effect of the PS adjustment. Major adverse cardiac and cerebrovascular events (MACCE: a composite of death, myocardial infarction, TTS recurrence, stroke or transient ischaemic attack) were assessed at 30-day and 5-year follow-up. A total of 1533 TTS patients with known status regarding aspirin prescription at discharge were included. According to the adjusted analysis based on PS stratification, aspirin was not associated with a lower hazard of MACCE at 30-day [hazard ratio (HR) 1.24, 95% confidence interval (CI) 0.50-3.04, P = 0.64] or 5-year follow-up (HR 1.11, 95% CI 0.78-1.58, P = 0.58). These results were confirmed by sensitivity analyses performed with alternative PS-based methods, i.e. covariate adjustment and inverse probability of treatment weighting. CONCLUSION: In the present study, no association was found between aspirin use in TTS patients and a reduced risk of MACCE at 30-day and 5-year follow-up. These findings should be confirmed in adequately powered randomized controlled trials. ClinicalTrials.gov Identifier: NCT01947621.

1st Department of Cardiology Medical University of Gdansk Gdansk Poland

1st Department of Medicine Faculty of Medicine University Medical Centre Mannheim University of Heidelberg Mannheim Germany

Cardiocenter 3rd Faculty of Medicine Charles University Prague and University Hospital Královské Vinohrady Prague Czech Republic

Center for Cardiology Cardiology 1 University Medical Center Mainz Mainz Germany

Center for Molecular Cardiology Schlieren Campus University of Zurich Zurich Switzerland

Centro Cardiologico Monzino IRCCS Milan Italy

Clinic for Cardiology and Pneumology Georg August University Goettingen Goettingen Germany

Department of Cardiology and Angiology Hannover Medical School Hannover Germany

Department of Cardiology and Cardiac Imaging Center University Hospital of Rangueil Toulouse France

Department of Cardiology Basil Hetzel Institute Queen Elizabeth Hospital University of Adelaide Adelaide Australia

Department of Cardiology Charité Campus Rudolf Virchow Berlin Germany

Department of Cardiology Heidelberg University Hospital Heidelberg Germany

Department of Cardiology John Radcliffe Hospital Oxford University Hospitals Oxford UK

Department of Cardiology Kantonsspital Frauenfeld Frauenfeld Switzerland

Department of Cardiology Kantonsspital Lucerne Lucerne Switzerland

Department of Cardiology Kantonsspital Winterthur Winterthur Switzerland

Department of Cardiology Kings College Hospital Kings Health Partners London UK

Department of Cardiology Leiden University Medical Centre Leiden The Netherlands

Department of Cardiology Medical University of Warsaw Warsaw Poland

Department of Cardiology University Heart Center University Hospital Zurich Zurich Switzerland

Department of Cardiology University Hospital Basel Basel Switzerland

Department of General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany

Department of Internal Medicine 3 Division of Cardiology Angiology and Intensive Medical Care University Hospital Halle Martin Luther University Halle Halle Germany

Department of Internal Medicine 3 Heart Center University of Cologne Cologne Germany

Department of Internal Medicine B University Medicine Greifswald Greifswald Germany

Department of Internal Medicine Cardiology Heart Center Leipzig University Hospital Leipzig Germany

Department of Internal Medicine II Cardiology University of Ulm Medical Center Ulm Germany

Department of Mathematical Sciences Politecnico di Torino Turin Italy

Department of Medicine College of Medicine University of Florida Gainesville FL USA

Department of Medico Surgical Sciences and Biotechnologies Sapienza University of Rome Latina Italy

Department of Molecular Medicine University of Pavia and Cardiac Intensive Care Unit and Laboratories for Experimental Cardiology IRCCS Fondazione Policlinico San Matteo Pavia Italy

Deutsches Herzzentrum München Technische Universität München Munich Germany

Division of Biological Sciences University of California San Diego San Diego CA USA

Division of Cardiology 'Antonio Cardarelli' Hospital Naples Italy

Division of Cardiology Department of Medical Sciences AOU Città della Salute e della Scienza University of Turin Turin Italy

Division of Cardiovascular Diseases Mayo Clinic Rochester MN USA

DZHK partner site Greifswald Greifswald Germany

DZHK partner site Hamburg Kiel Luebeck Hamburg Germany

DZHK partner site Heidelberg Mannheim Mannheim Germany

DZHK partner site Munich Heart Alliance Munich Germany

Fondazione Policlinico Universitario A Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy

Heart and Vascular Centre Bad Bevensen Bad Bevensen Germany

Heart Center Turku University Hospital and University of Turku Turku Finland

Heart Department University Hospital 'San Giovanni di Dio e Ruggi d'Aragona' Salerno Italy

Intensive Coronary Care Unit Moscow City Hospital 1 named after N Pirogov Moscow Russia

Internal Medicine Cardiology Angiology and Pneumology Magdeburg University Magdeburg Germany

Klinik für Innere Medizin 3 Universitätsklinikum des Saarlandes Homburg Germany

Krankenhaus Maria Hilf Medizinische Klinik Stadtlohn Germany

Royal Brompton and Harefield Hospitals Trust and Imperial College London UK

Section of Cardiac Electrophysiology Department of Medicine University of California San Francisco San Francisco CA USA

Structural Interventional Cardiology University Hospital Careggi Florence Italy

TJ Health Partners Heart and Vascular Glasgow KY USA

University Hospital for Internal Medicine 3 Medical University Innsbruck Innsbruck Austria

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ClinicalTrials.gov
NCT01947621