Risultati per: Progressi nel trattamento della psoriasi: review

Circulation, Volume 150, Issue Suppl_1, Page A4145690-A4145690, November 12, 2024. Background:Sodium-glucose cotransporter 2 (SGLT2) inhibitors have demonstrated cardiovascular benefits beyond glycemic control, including potential anti-arrhythmic effects. The impact of SGLT2 inhibitors on atrial fibrillation (AF) recurrence following catheter ablation in diabetic patients is an area of emerging interest. The purpose of this meta-analysis was to evaluate the impact of SGLT2 inhibitors on AF recurrence following catheter ablation in patients with diabetes.Methods:A comprehensive literature search was carried out using PubMed, Embase, and Google Scholar databases for the studies comparing SGLT2 inhibitors with other antidiabetic drugs in AF patients undergoing catheter ablation. Using random effect models, Mantel-Haenszel odds ratios and associated 95% confidence intervals were produced to report the overall effect size. Statistical significance was set at p < 0.05. Egger's regression test and Begg-Mazumdar's rank test were used to assess publication bias. The primary endpoint was the reoccurrence of atrial fibrillation after catheter ablation during the follow-up period, which varied between studies and ranged from 12 to 33 months.Results:The analysis included six studies, involving a sample size of around 5,765 AF patients. Our study reported that the use of SGLT2 inhibitors in diabetic patients undergoing catheter ablation for AF was associated with lower odds of AF reoccurrence (OR: 0.46; 95% CI: 0.32 to 0.65; p 0.05).Conclusion:The use of SGLT2 inhibitors was associated with improved outcomes post-catheter ablation for AF diabetic patients. Further large-scale, randomized controlled trials are warranted to confirm these findings and elucidate the underlying mechanisms.

Circulation, Volume 150, Issue Suppl_1, Page A4117406-A4117406, November 12, 2024. Objectives:This meta-analysis sought to explore the long-term arrhythmic outcomes of cardiac sympathetic denervation (CS) by measuring event rates of recurrent ventricular arrhythmias (VA) and implantable cardiac defibrillator shocks (ICD) post CSD.Background:The role of sympathetic nervous system in the beginning and continuation of ventricular arrhythmias (VAs) is well known. CS has been associated with improved arrhythmic outcomes in patients with refractory ventricular arrhythmias. However, whether CSD lowers shock event rates after the procedure is still uncertain and therefore, we performed a systematic review and meta-analysis to evaluate this.Methods&Materials:A comprehensive literature search was performed at Medline and Embase until March 2023. Our primary outcome was event rate of ICD shocks at 30 days, 90 days, and 1 year following CS. All analysis was conducted using Comprehensive Meta-Analysis software.Results:The initial search found 1,324 articles. After all articles were examined, a total of 29 studies fit our criteria. ICD shocks 1 year post CSD had a pooled event rate of 66.5% with a 95% confidence interval (CI) of 57.7% to 74.3% and the I-squared (I2) statistics. ICD shocks at 6 months had an event rate at 61.7% with a 95% confidence interval of 53.3% to 69.4% with I2 at 46. VA in one year post CSD had a pooled event rate of 62.5 with a 95% with a CI of 53.3% to 69.1% and I2 at 22%. At 6 months the event rate was 64.2 with a 95% CI of 56.3% to 71.4% with I2 at 33% Mortality from cardiac arrhythmia and classified 0-30 days (short term), 21-364 days (medium term), and >365 days (long term). The pooled event rate for short term morality was 6.8% with a 95% CI of 4.2%-11.0% with I2 at 0%, medium term was 5.2% with a 95% CI of 2.9% to 8.9% with I2 at 0%, and long term was 5.0% with a 95% CI of 2.7% to 9.2% and I2 at 0%.Conclusion:CSD may be an alternative form of therapy that reduces shock event rates and recurrent VA in patients that are refractory to ablation and medical therapy. However larger prospective studies are needed to further evaluate the usefulness and safety of CSD.

Circulation, Volume 150, Issue Suppl_1, Page A4139802-A4139802, November 12, 2024. Background:SGLT2 inhibitors improve cardiovascular outcomes in patients with heart failure and chronic kidney disease. However, the evidence on their efficacy in patients who have had acute myocardial infarction is still lacking. This systematic review and meta-analysis aimed to assess the safety and efficacy of SGLT2 inhibitors on cardiovascular outcomes in patients with a recent acute myocardial infarction.Methods:We searched various electronic databases including MEDLINE (via PubMed), Embase, the Cochrane Library, and Clincaltrials.gov to retrieve randomized controlled trials comparing SGLT2 inhibitors to placebo in patients with acute myocardial infarction. We performed statistical analysis on RevMan 5.4 using the random effect model. We reported dichotomous outcomes as relative risk (RR) along with 95% confidence intervals (CI) and continuous outcomes as mean difference (MD) along with 95% CI.Results:Our meta-analysis included 6 RCTs involving 11,256 patients. SGLT2i significantly decreased the rate of hospitalization for heart failure (RR 0.73, 95% CI: 0.61-0.88, I2=0%) with no significant change in mortality (RR 1.05, 95% CI: 0.78-1.40, I2=25%). There was no significant change between the two groups when assessing the rate of all-cause hospitalization (RR 1.00, 95% CI: 0.84-1.17, I2=%), cardiovascular death (RR 1.03, 95% CI: 0.83-1.28, I2=%), hepatic injury (RR 1.99, 95% CI: 0.54-7.40, I2=%), ketoacidosis (RR 2.00, 95% CI: 0.18-22.01, I2=%), hypoglycemia (RR 0.80, 95% CI: 0.21-2.97, I2=%), or lower limb amputation (RR 1.80, 95% CI: 0.60-5.36, I2=%). The mean change in NT-pro BNP (MD -0.28 95% CI: -0.61-0.05, I2=0%] and LVEF at follow-up (MD 0.62, 95% CI -0.73-1.97, I2=0%] were also comparable between the two groups.Conclusion:SGLT2i reduces the rate of hospitalization for heart failure with no change in mortality or other cardiovascular outcomes. Further high-quality and large-scale RCTs are required to confirm or refute our findings and provide more reliable results.

Circulation, Volume 150, Issue Suppl_1, Page A4145634-A4145634, November 12, 2024. Background:Catheter ablation has been increasingly used for managing atrial fibrillation (AF), to restore and maintain normal sinus rhythm. Despite its widespread use, it is unclear if there are differences in clinical outcomes, particularly in maintaining rhythm control and safety outcomes, between younger and older adults undergoing catheter ablation. The objective of this meta-analysis was to compare the outcomes following catheter ablation in younger and older adults.Methods:A comprehensive literature search was conducted using the PubMed, Embase, and Google Scholar databases. Using random effect models, mantel-Haenszel odds ratios and associated 95% confidence intervals were calculated to report the overall effect size. The primary endpoints were AF/atrial tachycardia (AT) recurrence and re-ablation requirement. Secondary outcomes included in-hospital complications such as stroke/TIA, cardiac tamponade/pericardial effusion, and vascular complications such as bleeding, hematoma, AV fistula, and femoral pseudoaneurysm. The young adult group varied between studies, ranging from under 30 years to under 45 years.Results:Data from 10 articles, with a sample size of about 126,141 AF patients, were considered. Our analysis indicated that catheter ablation for AF in the younger age group was linked to reduced odds of AF/AT reoccurrence (OR: 0.60; 95% CI: 0.44 to 0.83; p=0.002) and a decreased need for re-ablation after the index procedure (OR: 0.72; 95% CI: 0.53 to 0.97; p=0.03). Furthermore, catheter ablation in younger adults was found to be associated with a lower risk of in-hospital procedural complications like stroke/TIA (OR: 0.59; 95% CI: 0.43 to 0.80; p=0.0008) and cardiac tamponade/pericardial effusion (OR: 0.53; 95% CI: 0.42 to 0.68; p

Circulation, Volume 150, Issue Suppl_1, Page A4114597-A4114597, November 12, 2024. Background:Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of ACS, myocardial infarction, and sudden death particularly among young women and individuals with few conventional atherosclerotic risk factors. We reveiwed possible risk factors that could predispose to SCAD.Methods:We reviewed 13 consecutive patients presenting with SCAD across three different institutions over a period of 5 yrs and determined risk fatcors associated with this disase entity.Results:13 patients presented with SCAD represented % 0.5 of the total number of patients who underwent cardiac cathaterizations for chest pain requiring admissions. 11/13 (84%) were female. 5/13 (38%) were Caucasian or Hispanic, and 3/13 (23%) were African-American. Mean age age was 49.3 + years. 8/13 (61%) had associated hyperlipidemia with LDL levels > than 110 mg/dL, 9/13 (64%) had an A1c < 5.6% and only 1/13 (0.07%) had A1c of 6.4%. HTN was present in 6/13 (46%) of patients, and family history of SCD or heart disease were only seen in 2/13 (15%). None of the patients had features suggestive of associated fibromuscular dysplasia or connecive tissue disease. D-dimer was elevated in 5/13 (38%) with average value of 1578 ng/dL. Inflammatory markers were reviewed, only 3 patient has had ESR and CRP ordered, and only 1/3 had a mildly elevated CRP 3.9 mg/dL. Only 1/13 (0.07%) required intervention which was due to further drop in her ejection fraction requiring PCI, with improvement in her symptoms. All patients were treated with dual anti-platelet therapy for 1 year, 1 was discontinued due to persitent chest pain and decision was made to treat with only aspirin. Traditionally, risks for SCAD were thought to be due to non-atheresclerotic factors, however our case series shows that more then 60% of patients had elevated LDL's and 46% with hypertension, implying that traditional atheresclerotic risk factors should not be ignored and may play a crucial role. Autoimmune diseases were not found in any of our patients.Conclusion and implications:In this series patients who had SCAD had conventional risk factors of CAD including HLD and hypertension. The variability of co morbidities makes the identification of specific risk factors very difficult and none of the patients had Fibromuscular dysplasia or any signs of inflammation. Elevated D Dimer was also seen in a majority of patients, and all but one was managed medically with a favorable outcome

Circulation, Volume 150, Issue Suppl_1, Page A4139659-A4139659, November 12, 2024. Introduction:Significant coronary atherosclerotic lesions that involve the ostium of the left anterior descending (LAD) artery (Medina 0,1,0) pose unique challenges. The two main techniques used for percutaneous coronary intervention (PCI) of ostial LAD lesions are ostial stenting (OS) and crossover stenting (CS), in which a stent is deployed across the lesion extending from the left main (LM) artery into the LAD. Several observational studies have compared the efficacy of the two techniques, but the results have been mixed with respect to clinical outcomes.Research Question:Is there a difference in efficacy between CS and OS in ostial LAD lesions based on pooled data from existing studies?Methods:A systematic review was performed for studies comparing CS and OS techniques with respect to long-term outcomes (≥1 year). We used the Mantel-Haenszel random effects model to compute relative risk (RR) with 95% confidence intervals (CI) comparing rates of major adverse cardiovascular events (MACE), all-cause mortality, myocardial infarction (MI), target lesion revascularization (TLR), and stent thrombosis (ST) between groups using the CS and OS techniques. In the secondary analysis, we included only studies with a high proportion ( >50%) of intravascular ultrasound (IVUS) use in the CS group, given guideline recommendations of intravascular imaging in LM stenting.Results:We included 1448 patients across eight studies. In the primary meta-analysis, there was no significant association between the stenting technique and MACE (RR 0.72, 95% CI 0.38-1.39), all-cause mortality (RR 0.88, 95% CI 0.34-2.33), MI (RR 0.73, 95% CI 0.36-1.48), and TLR (RR 0.62, 95% CI 0.38-1.01). CS was favored with respect to ST (RR 0.34, 95% CI 0.13-0.93, p=0.04). There was significant heterogeneity between studies. In the secondary analysis, CS was favored with respect to MACE (RR 0.56, 95% CI 0.34-0.94, p=0.03) when including only studies that employed a high percentage of IVUS use in LM stenting. No significant differences were found with respect to all-cause mortality, MI, TLR, or ST.Conclusion:Based on our study, CS and OS appeared similar with respect to MACE, death, MI, and TLR, though there was significant heterogeneity across studies. CS did appear to be associated with lower ST. Moreover, CS was more favorable with a lower risk for MACE when IVUS was used more frequently, suggesting the importance of intravascular imaging in ostial LAD PCI.

Circulation, Volume 150, Issue Suppl_1, Page A4145520-A4145520, November 12, 2024. Background:The previous literature reports similar cardiovascular (CV) benefits for either percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in patients with left main coronary artery disease (LMCAD). However, limited data exist on the influence of prior cerebrovascular disease (CEVD) in such patients. Thus, our aim is to compare the CV outcomes in patients with LMCAD and prior CEVD, undergoing either PCI or CABG.Methods:A comprehensive search of electronic databases, PubMed, SCOPUS, and Cochrane Central was conducted from their inception till May 2024. Outcomes of interest included all-cause mortality, major adverse cardiac and cerebrovascular events (MACCE), Myocardial Infarction (MI), and risk of stroke in patients undergoing either PCI or CABG for LMCAD. Data were pooled and analyzed using a random effects model and presented as hazard ratios (HR) along with their 95% confidence intervals (CI). Heterogeneity was quantified using the I(2) index.Results:We included three studies in our analysis (n = 5,732). Our analysis demonstrated that in patients with prior CEVD, PCI lead to significantly increased risk of MACCE (HR = 2.56, 95% CI:[1.23, 5.37], p = 0.01] and MI (HR = 2.97, 95% CI: [1.72, 5.13], p< 0.01). While an elevated risk of all-cause mortality (HR: 1.35, 95% CI: [0.92, 1.98]; p = 0.12) and repeat stroke (HR: 1.67, 95% CI: [0.81, 3.42], p = 0.16) was observed, these were comparable across procedures. Similarly, an elevated but comparable risk of repeat revascularization was observed between the two procedures (HR: 3.44, 95% CI: [0.50, 23.60]; p = 0.21).Conclusion:Our results show that PCI significantly elevates the risk of MACCE and MI in patients with prior CEVD compared to CABG. However, risks of all-cause mortality, repeat stroke, and revascularization were comparable. The increased risk of adverse CV events in CEVD patients may be due to co-morbidities like hypertension, smoking, diabetes, peripheral vascular disease, renal insufficiency, inflammation, and hypercoagulability. We recommend including prior CEVD in pre-operative assessments for revascularization and developing novel strategies for patients with LMCAD and prior CEVD.

Circulation, Volume 150, Issue Suppl_1, Page A4139484-A4139484, November 12, 2024. Background:Cardiac sarcoidosis (CS) is a rare condition marked by conduction disturbances, and ventricular tachycardia (VT) resulting from reentrant pathways. VT ablation is typically considered for patients with refractory VT. This systematic review aims to synthesize reported outcomes and identify potential predictors for the success of VT ablation in CS patients.Methods:A systematic literature review was conducted following the PRISMA guidelines, searching PubMed, Cochrane, Embase, and Scopus databases up to May 2024. A random-effects model was used to evaluate electrophysiologic and procedural variables and compare outcomes to identify potential predictors of success.Results:After excluding duplicates, 473 titles and abstracts were screened. Twenty-five studies were fully reviewed, and 9 studies comprising data from 311 CS patients who underwent VT ablation were included. The mean age of patients was 50.5 years, with 30% being female. Epicardial mapping was performed in 29% (CI 22-36%; 72/251) of cases, and 96% (CI 77-100%; 65/72) of those underwent epicardial ablation. The prevalence of VT storm before the procedure was 28% (CI 16-42%; 89/259), with a suppression success rate of 84% (CI 73-93%; 64/76). The acute complete success rate defined as lack of inducibility was 58% (CI 49-66%; 174/307). During follow-up, which ranged from 19 to 58 months, 34% (CI 21-48%; 113/271) of patients survived free from the composite outcome of death, transplantation, or VT recurrence. Patients with acute success had fewer inducible VTs (MD –1.1; CI: -1.8 to -0.5; p < 0.001). No other variables were significantly associated with acute success. However, patients with acute success tended to be older than those with partial or unsuccessful outcomes (MD 7.5; CI: -0.2 to 15.1; p = 0.055).Conclusion:VT ablation in patients with CS shows acceptable acute success rates. Patients presenting with VT storm have a high rate of arrhythmia acute suppression. A lower number of inducible VTs is associated with higher acute success rates. Despite these results, the prognosis remains poor, with a significant proportion of patients experiencing disease recurrence, death, or requiring heart transplantation.

Circulation, Volume 150, Issue Suppl_1, Page A4144289-A4144289, November 12, 2024. Introduction:Atrial fibrillation is the most encountered arrhythmia in clinical settings, with an estimate of 6 million cases in the United States. A growing amount of evidence has been supporting the role of left atrial appendage in left sided atrial fibrillation with conflict results. We aim in this study to provide a more in-depth guide for optimal left sided atrial fibrillation ablation strategy.Methods:We searched PubMed, Web of Science, Cochrane and Scopus for published studies until May 2024. We included relevant studies that compared the left atrial appendage electrical isolation versus the standard ablation and reported our outcomes of interest. The main outcomes of the study were the recurrence of atrial arrhythmia and the incidence of stroke or transient ischemic attack during the follow-up period. Data were pooled as Mean difference (MD) or risk ratio (RR) with their 95% CI using a fixed-effect model.Results:Eleven studies with 3040 patients were included in the final analysis. Left atrial appendage electrical isolation was associated with a significant reduction in atrial arrhythmia recurrence compared to the standard ablation alone (OR: 0.41, 95% CI: 0.35 to 0.48). However, it was also associated with a significant increase in stroke or transient ischemic attack incidence (OR: 1.48, 95% CI: 1.09 to 3.12).Conclusion:Left atrial appendage electrical isolation led to a significantly lower atrial arrhythmia recurrence, but this was achieved with an increased risk of stroke and transient ischemic attack incidence during the follow-up period.

Circulation, Volume 150, Issue Suppl_1, Page A4144270-A4144270, November 12, 2024. Background:Air pollution is a leading cause of cardiovascular diseases including ischemic heart disease and stroke contributing to millions of deaths, with elevated blood pressure, endothelial dysfunction, and systemic inflammation being some of the most important underlying mechanisms. Various studies showed a promising beneficial effect of indoor air purification on various health outcomes, including blood pressure. We aimed to assess the effect of indoor air purification on systolic blood pressure (SBP) and Diastolic blood pressure (DBP) and provide a rationale for home use of these filters.Methods:We searched PubMed, Web of Science, Cochrane and Scopus for published literature up to May 2024. We included studies that assessed air purification, including HEPA filters or electrostatic air filters, as an intervention compared to no intervention. The primary outcome of interest was mean changes in blood pressure both systolic and diastolic. Secondary outcomes were biomarkers of inflammation and oxidative stress. Mean difference (MD) and 95% CI was used in a fixed-effect model to analyze the data.Results:A total of 21 studies were included in our meta-analysis with a total of 1955 participants. Air purification was associated with a significant reduction in systolic blood pressure (SBP) (MD: -2.42, 95% CI: -3.42, -1.41), and diastolic blood pressure (DBP) (MD: -1.11, 95% CI: -1.76, -0.46). However, there was no significant changes in levels of inflammatory biomarkers or oxidative stress.Conclusion: Indoor air purification was associated with significant reductions in systolic and diastolic blood pressure levels, but questions arise whether these reductions are clinically relevant or not. Further studies should assess these findings.Conclusion:Indoor air purification was associated with significant reductions in systolic and diastolic blood pressure levels, but questions arise whether these reductions are clinically relevant or not. Further studies should assess these findings.

Circulation, Volume 150, Issue Suppl_1, Page ASu1103-ASu1103, November 12, 2024. Background:Older adults are at high risk for experiencing out-of-hospital cardiac arrest, and therefore they are an important target for CPR training efforts. Physical, mental, and other barriers associated with advanced age present plausible obstacles to training/learning, and may warrant a need for tailored training programs.Hypothesis:Barriers to CPR training for older adults may be widely characterized, but efforts to resolve them are limited.Goal:This literature review’s purpose is to consolidate existing knowledge on teaching CPR to older adults and identify any gaps for future study.Methods:A complete search in both CINAHL and PubMed was conducted for the capture period 2014-2024. The terms “CPR”, “bystander CPR”, “older adult”, “training”, “development”, “out-of-hospital cardiac arrest”, “chest compressions”, and synonyms were used. The full search strategy will be shared at time of presentation. Search results not mentioning CPR, elderly people, and training of older adults were excluded. Any duplicates between the two databases were resolved. Included articles were reviewed by 2 researchers. Age, sex, and study designs were documented and summarized, with ranges, percentages or means reported where appropriate.Results:A total of 14 articles from CINAHL (n=8) and PubMed (n=6) were selected and were either qualitative surveys (n=4) or randomized control trials (n=10). In the studies reviewed, disparate knowledge or retention of CPR skills in older adults was linked to increased course duration or intricacy, physical or mental limitations (real or perceived), and lack of confidence. When analyzing the participants, the definition of older adult ranged from 55 to 65 years old and above with variable sample sizes (n=21-119, median=58). All the studies that documented sex had over 53% of older adults being female (n=53%-100%, median=64.85%). Studies identified methods to address limitations in older adults, including employing continuous chest compression delivery (versus 30:2) to improve quality/compliance, and Andrew’s Maneuver, also known as 4-hands CPR, for increasing effective compression depth while mitigating limited mobility and frailty.Conclusion:Within current literature, established best practices for teaching older adults CPR are limited, and few studies attempt to characterize the limitations of training older adults. Of those studies available in the literature, valuable foundations are available for future work.

Circulation, Volume 150, Issue Suppl_1, Page A4144988-A4144988, November 12, 2024. Background:The neutrophil-to-lymphocyte ratio (NLR) is a novel inflammatory marker predicting cardiovascular mortality (CVM) and all-cause mortality (ACM) among the general population. We aim to investigate this association in patients who underwent peritoneal dialysis (PD).Methods:We systematically reviewed articles from PubMed, Google Scholar, and Scopus until May 2024 on the association of ACM and CVM in patients with NLR following PD. We used a fixed effects model, 95% confidence intervals (CI), and I2statistics to pool unadjusted and adjusted hazard ratios (HR) and measure heterogeneity. Leave-one-out sensitivity analysis was employed to study how each study alters the overall effect of the studies. Multivariate meta-regression was utilized to identify influencing confounding factors. Quality assessment of the studies was done through the Joanna Briggs Institute (JBI) tool. For all results, a P value < 0.05 was considered significant.Results:Out of 160 articles screened, seven studies spanning from 2011 to 2023 with 4,350 patients, a mean age of 49.9 ± 15, and a median follow-up of four years were included in our meta-analysis. We found that higher NLR ( >2.88) was significantly associated with ACM (aHR: 1.09, 95% CI: 1.05–1.12, p2.88) and outcomes such as ACM and CVM. This association can help prevent deaths in the older population and encourage proper utilization of the elderly resources. Additionally, age was a significant potential confounder for ACM in patients who are receiving PD. Thus, caution should be taken when predicting mortality in the elderly population.

Circulation, Volume 150, Issue Suppl_1, Page A4138221-A4138221, November 12, 2024. Background:Dyslipidemia is a major risk factor for Atherosclerotic Cardiovascular Disease (ASCVD). Statin is a crucial intervention to fix dyslipidemia and reduce the ASCVD risk. Still, there are several regimens to achieve blood lipid level targets, including increasing the statin dose or adding ezetimibe to the statin used. However, the best option between the two regimens is still a matter of debate.Research Question:We aim to evaluate the efficacy and safety of Ezetimibe plus any type of statin versus a double dose of the same statin in patients with ASCVD risk.Methods:A systematic review and meta-analysis based on randomized controlled trials (RCTs) obtained from PubMed, Embase Cochrane, Scopus, and WOS till December 2023. We used the random-effects model to report dichotomous outcomes using odds ratio (OR) and continuous outcomes using mean difference (MD), with a 95% confidence interval (CI).Results:Forty-seven studies with a total of 18592 patients were included. Ezetimibe plus statin was associated with a decrease in low-density lipoprotein (LDL) levels [MD: -13.69 with 95% CI (-15.64, -11.74), P

Circulation, Volume 150, Issue Suppl_1, Page A4147488-A4147488, November 12, 2024. Background:Previous studies have shown that influenza vaccination (IV) may reduce the incidence of cardiovascular events in patients with cardiovascular disease. In this meta-analysis, we aimed to clarify the effects of IV in patients with myocardial ischemia (MI) and heart failure (HF).Hypothesis:The influenza vaccine reduces the incidence of major adverse cardiovascular events among patients with MI and HF.Methods:A comprehensive search was performed in PubMed, Cochrane Library, and Embase databases from inception up to march 2024. We included randomized clinical trials (RCTs) that assessed the effects of IV in patients with HF and MI, and reported outcomes of major adverse cardiovascular events (MACE), cardiovascular death, and all-cause death. Analyses were conducted using R software. Heterogeneity was assessed using the I2 statistic. A random-effects model was applied to calculate pooled Relative Risk (RR). A stratified analysis was performed to investigate ST-segment elevation myocardial infarction (STEMI) and non-STEMI subgroups. Sensitivity analysis was performed to explore heterogeneity. Confidence Interval (CI) was set at 95%.Results:We identified six RCTs comprising a total population of 9229 participants. Of these, 4100 were patients with MI, and 5129 were HF patients. Overall, MACE (RR 0.65; 95%CI 0.47-0.89; p=0.007; I2=75%) (Figure 1A) and cardiovascular death (RR 0.60; 95%CI 0.37-0.96; p=0.035; I2=62%) (Figure 1B) were significantly lower in group receiving IV compared to placebo/no treatment. No statistically significant difference was observed for all-cause death. In sensitivity analysis, after excluding HF patients, IV significantly decreased the risk of MACE (RR 0.57; 95%CI 0.43-0.76; p

Circulation, Volume 150, Issue Suppl_1, Page A4144305-A4144305, November 12, 2024. Background and Purpose:Transfemoral access (TFA) has been the standard for neuro-interventional procedures, but it carries risks such as pseudoaneurysm formation and arterial occlusion. Transradial access (TRA) is a newer alternative that may reduce these complications. This study aims to compare the clinical outcomes of TRA versus TFA in mechanical thrombectomy (MT) for acute ischemic stroke (AIS).Methods:A systematic review and meta-analysis was conducted following PRISMA guidelines. Databases searched included PubMed/MEDLINE, Cochrane Library, and Google Scholar up to April 7, 2024. A random-effects model was used for analysis, and study quality was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias (RoB 2) tool.Results:The search identified 1389 records, and 13 studies (12 observational, 1 RCT) with 4803 patients (TRA: 855, TFA: 3948) were included. TRA showed no significant difference in successful recanalization (TICI 2b-3) compared to TFA [RR: 0.98; 95% CI: 0.94 – 1.03]. Complete recanalization (TICI 3) was also similar [RR: 1.08; 95% CI: 0.96 – 1.21]. Fluoroscopy time, reported by four studies, showed no significant difference [RR: -1.76; 95% CI: -7.54 – 4.02]. Hospital stay duration from three studies was comparable [MD: -0.52; 95% CI: -1.25 – 0.21]. The access-to-perfusion time reported by ten studies showed no significant difference [MD: -1.70; 95% CI: -8.11 – 4.72]. The mean number of passes from eight studies showed no significant difference [MD: 0.10; 95% CI: -0.06 – 0.27].Procedural complications were lower in the TRA group but not statistically significant [6.09% vs. 8.77%, RR: 0.71; 95% CI: 0.46 – 1.09]. TRA had significantly fewer access site complications [RR: 0.23; 95% CI: 0.08 – 0.62]. Symptomatic intracranial hemorrhage from seven studies showed no significant difference [RR: 1.0; 95% CI: 0.72 – 1.38]. NIHSS score at discharge showed no significant difference [MD: 1.31; 95% CI: -2.14 – 4.76]. In-hospital mortality from two studies showed no significant difference [RR: 0.56; 95% CI: 0.26 – 1.20]. Ninety-day mortality from three studies showed no significant difference [RR: 1.15; 95% CI: 0.98 – 1.36].Conclusion:TRA is as effective as TFA for MT in AIS and significantly reduces the risk of access site complications. Further large-scale RCTs are warranted to confirm these findings and refine the clinical guidelines for optimal access strategy in neuro-interventional procedures.

Circulation, Volume 150, Issue Suppl_1, Page A4146112-A4146112, November 12, 2024. Background:Despite optimal therapy, coronary artery disease (CAD) remains a significant public health concern in the United States. The literature increasingly acknowledges the role of inflammation in the development of atherosclerosis. Colchicine, a potent anti-inflammatory drug commonly used to treat gout and pericarditis, is being evaluated in this study for its safety and efficacy in preventing CAD following an acute coronary syndrome (ACS).Methods:We searched PubMed and Embase to find studies up to April 2024 that compared colchicine to placebo in patients with ACS. The primary outcomes were major adverse cardiovascular events (MACE), stroke, recurrent ACS, and recurrent hospitalizations. Secondary endpoints consisted of cardiovascular death and the incidence of congestive heart failure (CHF). We also examined the gastrointestinal effects of colchicine in all subjects. To combine the data, we used the random-effects model.Results:We included ten studies with a pooled sample size of 7,260 patients. The mean age was 60.1 (±11.8) years, with 19.3% females and an average follow-up duration of 8.5 (±6) months. Patients who received colchicine treatment demonstrated a reduced risk of MACE (OR: 0.72, 95% CI: 0.59-0.88, p- 0.001), stroke (OR: 0.41, 95% CI: 0.20-0.84, p- 0.01), recurrent ACS (OR: 0.73, 95% CI: 0.57-0.93, p- 0.01), and hospitalization (OR: 0.52, 95% CI: 0.34-0.81, p- 0.003). However, there was no significant difference in cardiovascular death (OR: 1.01, 95% CI: 0.60-1.72, p- 0.95) and the incidence of CHF (OR: 1.04, 95% CI: 0.64-1.69, p-0.89) between patients treated with colchicine and those without. Notably, patients treated with colchicine experienced more gastrointestinal effects than those without colchicine treatment (OR: 1.16, 95% CI: 1.02-1.32, p-0.02).Conclusion:Adding colchicine to standard medical therapy in ACS patients significantly reduced the incidence of major adverse cardiovascular events, stroke, recurrent ACS events, and hospitalizations. Further prospective trials are required to validate these findings and determine if early intervention with colchicine treatment improves clinical outcomes in ACS patients.