A systematic review and meta-analysis of clinical outcomes of Takotsubo syndrome in patients with cancer

Abstract Background Recent studies suggested a relationship between Takotsubo syndrome (TS) and malignancy. However, the clinical outcomes of TS associated with cancer have not fully been assessed. Purpose The aim of this study was to investigate the outcomes of TS for patients with cancer. Methods We performed a systematic review and meta-analysis to evaluate the clinical outcome of TS in patients with and without malignancy. We searched for observational studies assessing the association of TS and malignancy until December 2022 in PubMed and Cochrane Library. The primary outcome was all-cause mortality. The secondary outcomes of this study were short-term mortality (in-hospital deaths or deaths within 30 days), shock, the need for mechanical respiratory support, and the need for mechanical circulatory support. A random-model meta-analysis was performed. Results Fourteen studies were finally included in this meta-analysis, totaling 189,210 patients with TS. The prevalence of current or previous malignancy among patients with TS was 8.7% (16,461 patients). Compared to patients without cancer, patients with malignancy demonstrated a higher risk of all-cause deaths in TS (odds ratio [OR], 2.41; 95% confidence interval [CI], 1.95-2.98; p < 0.01; I2 = 74%; p for heterogeneity < 0.01). Cancer was significantly associated with an increased risk of short-term mortality (OR 1.97; 95% CI 1.75-2.22; p < 0.01; I2 = 0%; p for heterogeneity = 0.46). Also, malignancy was significantly associated with in-hospital shock and mechanical respiratory support (shock; OR 1.42; 95% CI 1.30-1.55; p < 0.001, mechanical respiratory support; OR 1.68; 95% CI 1.59-1.77; p < 0.01) but not mechanical circulatory support (OR 1.12; 95% CI 0.68-1.84; p = 0.66). Conclusion In this meta-analysis, either previous or active cancer was associated with an increased risk of all-cause mortality, short-term mortality, shock, and needs for mechanical respiratory support in patients with TS.