Risultati per: Infezione da Helicobacter pylori: review

Circulation, Volume 150, Issue Suppl_1, Page A4141125-A4141125, November 12, 2024. Background:Left atrial (LA) strain is an established marker of LA function. Our previous meta-analysis (Pathan, 2017) from 2,542 healthy subjects reported 39.4% with lower limit of normal (LLN) at 38.0%. However, subsequent original studies revealed much lower LLN, ranging from 15.1% to 28.2% (Figure). The LLN is critically important for clinical practice to distinguish abnormal LA function from normal. Thus, we hypothesised that a Bayesian meta-analysis to pool LLN from healthy individuals would determine a clinically meaningful cut-off threshold for LA strain.Aim:As there has been a large number of recent studies reporting normal LA strain since 2017, we aimed to update our systematic review and run Bayesian analysis for LLN of LA strain.Methods:Following PRISMA Guidelines, an updated systematic review was conducted by searching PubMed, Embase, and Scopus databases. Studies of LA strain were included if they involved >20 healthy patients without cardiac disease or risk factors between 2016 and September 2022. Mean LA reservoir strain with 95% confidence intervals were extracted from eligible studies. We use Bayesian meta-analysis to pool the lower 95% confidence interval of the LA reservoir strain from included studies. Prior to pooling the result, we standardised the data with log transformation. The priori used in this model was based on weak informative prior with N (0,1) as the prior distribution. The posterior mean was then exponentiated to obtain the lower reference value and its 95% credible interval (CI).Results:Sixty-three studies (10,533 healthy patients) satisfied inclusion criteria. Our updated Bayesian Meta-analysis demonstrated a pooled mean of 37.8% [95% CI: 36.1, 39.4] with LLN at 22.4% [20.6, 24.3], which is more concordant with recent original studies (Figure).Conclusions:The normal mean LA strain has been updated by pooling >10,000 subjects. The updated LLN of 22.5% may represent a better clinical cut-off for normal LA strain to identify individuals with abnormal LA strain.

Circulation, Volume 150, Issue Suppl_1, Page A4141828-A4141828, November 12, 2024. Background:The combination of ibrutinib and venetoclax has emerged as a promising therapeutic option for patients with chronic lymphocytic leukemia (CLL), demonstrating significant advantages compared to traditional chemotherapy-based approaches. However, the potential adverse cardiovascular effects, especially in patients who have not previously undergone treatment, have not been fully elucidated.Hypothesis:The use of ibrutinib and venetoclax is associated with a higher incidence of cardiovascular adverse events.Aims:This study aims to analyze the incidence of cardiovascular adverse effects in patients treated with ibrutinib and venetoclax for CLL, who were previously naïve to treatment.Methods:PubMed, Embase, and Cochrane Central databases were systematically searched in April 2024 for randomized controlled trials (RCTs) that compared ibrutinib plus venetoclax to standard care therapies (ST) (chlorambucil-obinutuzumab; ibrutinib only and fludarabine-cyclophosphamide-rituximab) in untreated patients with CLL and reported the outcomes of (1) atrial fibrillation; (2) hypertension and (3) sudden death. We performed a systematic review and meta-analysis using RStudio version 2024.04.0. Heterogeneity was examined with the Cochran Q test and I2 statistics.Results:We included 4 RCTs in the final analysis, with a total of 885 participants, of whom 450 (50.8%) were on ibrutinib plus venetoclax. Ibrutinib plus venetoclax was associated with a significant increase in the incidence of atrial fibrillation compared with standard care therapy (OR 7.04; 95% CI 3.11-15.92; p

Circulation, Volume 150, Issue Suppl_1, Page A4145344-A4145344, November 12, 2024. Background:The prevalence of atrial fibrillation (AF) increases with age. However, limited data are available regarding the prognostic implications of rhythm versus rate control strategies for AF in the elderly. We have conducted this systematic review and meta-analysis to explore the effects of early rhythm control strategy in elderly (age >65 years) AF patients.Methods:A literature search was conducted for relevant studies using MEDLINE (PubMed), EMBASE, Scopus, Cochrane CENTRAL, Conference Abstracts, and ClinicalTrials.com through March 19th, 2024. The primary outcome was all-cause mortality. Meta-analysis was performed using the random-effects Mantel-Haenszel method, and pooled risk ratios (RRs) along with 95% confidence intervals (CIs) were calculated using RevMan 5.4.Results:Six studies with 39,181 patients (rhythm control 11,446; rate control 27,735) were included. The mean age was 79 years in the rhythm control and 81 years in the rate control cohort. Females were 52% in rhythm control and 55% in the rate control group. The rhythm control strategy was associated with a lower risk of stroke (RR 0.73, 95%CI 0.66-0.81, p

Circulation, Volume 150, Issue Suppl_1, Page A4142244-A4142244, November 12, 2024. Background:Multivessel coronary artery disease has a higher risk of adverse cardiovascular outcomes. Although patients presenting with STEMI usually undergo revascularization of the infarct-related artery only (i.e. cuplrit only percutaneous coronary intervention or CO-PCI), recent trials suggest improved outcomes with complete PCI of all arteries with chronic total occlusion (CTO).Aim:To meta-analyze data from randomized controlled trials comparing the impact of complete versus CO-PCI in STEMI patients with CTO in the non-infarct related artery (non-IRA).Methods:We conducted a comprehensive search of Medline, EMBASE, and Scopus up till May 2024, to identify studies comparing the clinical outcomes between CO-PCI versus complete PCI in patients with STEMI accompanied by CTO in the non-IRA. Effect estimates were pooled using a random-effects model and reported as risk ratios (RR) along with corresponding 95% confidence intervals (CIs), with a significant p value < 0.05. Outcomes of interest include all-cause and cardiac mortality, myocardial infarction and stroke.Results:Our search strategy yielded 16 eligible studies (complete PCI, n= 7,982; CO-PCI, n= 7,753). Complete PCI significantly reduced all-cause mortality in comparison to CO-PCI (RR=0.64 [0.49, 0.84]; p=0.002). Complete PCI was also associated with a significant reduction in cardiac death (RR: 0.54 [0.41 - 0.72]; p

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 A4140745-A4140745, November 12, 2024. Introduction:Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is being increasingly utilized for cardiogenic shock (CS). We compare the outcomes of using isolated mechanical circulatory support (MCS) versus Impella or intra-aortic baloon pump (IABP) for left ventricular unloading (LVU) in the context of VA-ECMO.Methods:We searched for Impella, VA-ECMO, and IABP utilization in acute myocardial infarction (MI) related cardiogenic shock. Primary outcomes included 30-day and 12-month mortality rates, major bleeding, and limb ischemia. Secondary outcomes were occurrence of major adverse cardiovascular events (MACE) and stroke. Data analysis utilized frequentist network meta-analysis with random-effects models, calculating odds ratios (OR) and 95% confidence intervals (CI).Results:We identified 22 studies, including 4 randomized controlled trials (RCTs) and 18 observational studies, involving a total of 79,149 participants. The average follow-up duration for these studies was 11 months, and the mean age of the included patients was 63 years. Regarding the 30-day mortality rate, IABP alone demonstrated a significant reduction compared to Impella and VA-ECMO [OR 0.54, 95% CI 0.40 to 0.72]. On the other hand, Impella alone exhibited the lowest 12-month mortality rate [OR 0.66, 95% CI 0.51 to 0.85]. Regarding complications, IABP showed a significantly lower risk of major bleeding [OR 0.29, 95% CI 0.14 to 0.61] and limb ischemia [OR 0.14, 95% CI 0.04 to 0.47] when compared to VA-ECMO and Impella. However, no significant difference was observed in the occurrence of stroke and MACE between Impella and IABP. Furthermore, there was no significant difference in the 30-day or 12-month mortality rate when VA-ECMO was combined with IABP or Impella.Conclusion:Impella offers significant long-term survival benefits, while IABP excels in short-term survival outcomes and reduces bleeding and thrombotic events with no significant difference in stroke and MACE risk.

Circulation, Volume 150, Issue Suppl_1, Page A4147438-A4147438, November 12, 2024. Introduction/Background:Right ventricular failure (RVF) is the inability of the RV to adequately perfuse pulmonary circulation and sufficiently fill the LV; it increases morbidity, mortality, and length of hospital stay. In critically ill patients, three main etiologies of RV failure are excessive preload, excessive afterload, and insufficient myocardial contractility. In addition to medical management, some patients at risk for refractory cardiogenic shock may require temporary mechanical circulatory support (TMCS).Research Questions/Hypotheses:The Impella RP flex (Abiomed, Danvers, MA) has provided an option for percutaneous RV support through the internal jugular vein and allows for early rehabilitation of complex cardiac patients.Methods/Approach:Consecutive cases at our center using the Impella RP flex were evaluated for hemodynamics and quality measures.Research/Data:Thirteen patients received RP flex support: 3 patients with pulmonary hypertension during mitral valve repair or replacement, 4 patients for prophylactic placement pre-LVAD, 3 patients with intraoperative placement during CABG, 2 patients with acute myocardial infarction, and 1 patient for salvage therapy. The average length of stay for our patients was 30.23 days; average duration of Impella support was 4.46 days.Twelve patients required inotropic support with milrinone and 91.7% received epinephrine. Of the 12 patients who required vasodilators, 100% received inhaled nitric oxide and 50% received sildenafil. Four patients required sildenafil at the time of discharge (36.4%).Internal jugular vein cannulation and intracorporeal support allows capable patients to participate in physical therapy early in the recovery process. Of our cohort, 30.77% of patients were successfully assisted out of bed to chair and 15.38% ambulated with assistance. All patients had pre- and post-creatinine levels collected, with an average pre-implantation creatinine level of 1.48 and post-explantation level of 1.76. The average pre-implantation lactic acid level was 4.75; only 11 patients had post-explantation lactic acid measurements collected, which averaged 3. Eleven patients were successfully discharged and no patients required home inotropes.Conclusions:The RP flex allows for RV unloading for patients requiring TMCS; it is best used early or prophylactically for patients who are otherwise high-risk for complications or who may require high-dose pressors and prolonged ICU level of care.

Circulation, Volume 150, Issue Suppl_1, Page A4125157-A4125157, November 12, 2024. Background:Recent evidence suggests that sodium-glucose cotransporter-2 inhibitors (SGLT2-i) may improve outcomes in patients with coronary artery disease (CAD) through various physiological pathways. However, their impact on patients who have undergone percutaneous coronary intervention (PCI) is not well established. This meta-analysis aims to evaluate the effectiveness of additive SGLT2 inhibitors versus standard therapy alone in patients with CAD after PCI.Methods:A systematic search was conducted across the Medline, Embase, and Cochrane Library databases for randomized controlled trials (RCTs) and observational studies that compared the addition of SGLT2 inhibitors to standard therapy versus standard therapy alone in patients post-PCI. The outcomes analyzed were Major Adverse Cardiovascular Events (MACE), all-cause death, cardiovascular death, recurrent acute myocardial infarction (AMI), nonfatal stroke, revascularization, and hospitalization for heart failure (HF).Results:A total of 7 studies met the inclusion criteria, encompassing a total of 11,800 individuals (5,004 on SGLT2-i and 6,796 non-SGLT2-i; mean age of 62.7 years; 28% women; 95% diabetic patients). SGLT2 inhibitors significantly reduced the risk of all-cause mortality (RR 0.6, 95% CI: 0.5-0.72, p

Circulation, Volume 150, Issue Suppl_1, Page A4140673-A4140673, November 12, 2024. Background:Considering the high prevalence and comparable five-year mortality rates of heart failure with preserved ejection fraction (HFpEF) to heart failure with reduced ejection fraction (HFrEF), and the inconsistent results regarding prognostic biomarkers for HFpEF, we aim to systematically review studies evaluating the prognostic role of common kidney function markers in HFpEF.Methods:Following PRISMA guidelines, a systematic search was performed in online databases from inception to March 2024. Studies that primarily assessed the association of blood urea nitrogen (BUN), uric acid (UA), creatinine (Cr), estimated glomerular filtration rate (eGFR), and cystatin-C with HFpEF outcomes were included. A random-effects meta-analysis was conducted to pool the hazard ratios (HRs) and their 95% confidence intervals (CIs) for a 1-unit increase in markers or higher levels versus lower levels for the incidence of adverse events, including all-cause mortality, HF readmission, cardiac mortality, and composite outcomes.Results:Out of 2491 reviewed studies, 80 were included. A significant correlation between BUN levels and HFpEF outcomes, mainly HF readmission and all-cause mortality, was found. The meta-analysis showed that a 1-unit increase in BUN was linked to a higher hazard of these events (HR 1.02, 95% CI 1.01 to 1.03, P = 0.0003). A 1-unit increase in UA resulted in a higher incidence of adverse events (HR 1.13, 95% CI 1.05 to 1.21, P = 0.0005). Higher serum Cr levels were linked to increased all-cause mortality, with a 1-unit increase in Cr leading to a higher incidence of adverse events (HR 1.17, 95% CI 1.06 to 1.29, P = 0.0017). Higher eGFR values were associated with lower mortality and hospitalization (HR 0.99, 95% CI 0.98 to 0.99, P < 0.0001). The predictive value of cystatin-C was also demonstrated, with its increased levels correlating with higher mortality and readmission, showing a higher hazard ratio (compared to others) of 1.43 (95% CI 1.21 to 1.75, P < 0.0001). It appears that among continuous variables, cystatin-C works better to predict adverse outcomes in HFpEF (figure).Conclusion:Renal function biomarkers play a significant role in predicting HFpEF outcomes, aiding in better risk assessment and patient management.

Circulation, Volume 150, Issue Suppl_1, Page A4135178-A4135178, November 12, 2024. Background:Tricuspid regurgitation (TR) is no longer considered forgotten. Transcatheter tricuspid valve repair/replacement (TVRR) has become widely accepted as gauged by clinical outcomes. FDA approved two tricuspid valve devices for the purpose of improving quality of life and not necessarily to improve TR severity. We aim to support evidence-based use of TVRR, by summarizing the latest evidence on the clinical effectiveness in terms of post-procedural length of hospital stay, readmissions for heart failure and procedure success if an Intracardiac device is present.Methods:We searched Pubmed, Embase and Cochrane databases and performed a meta-analysis of the included cohort studies using a fixed-effects model. Studies were excluded if they did not present an outcome in each intervention group or did not have enough information required for continuous data comparison. We performed a meta-analysis of hazard ratio (HR) for two outcomes and odds ratio (OR) for one outcome using the random effects model to remove inconsistency and compared the results with fixed effects model. The compared findings of both methods were similar. The variables used for analysis were number of events in exposure group and total amount of events. All data analyses were performed using MedCalc® Statistical Software version 22.023.Results:Of 161 potentially relevant studies, 8 retrospective studies with a total of 1,717 patients were included in the meta-analysis. Procedure (TVRR) success was associated with fewer readmissions for heart failure in all three studies included in the analysis of pooled HR (HR = 0.46, 95% confidence interval [CI]: 0.33 – 0.63, p

Circulation, Volume 150, Issue Suppl_1, Page A4146032-A4146032, November 12, 2024. Background:Stress testing is a well-established non-invasive method commonly used in clinical practice for patients with angina. However, its benefit in diabetic patients after coronary intervention remains unclear. This systematic review aims to address this knowledge gap by evaluating the impact of routine stress testing in this specific patient population.Research Question:Does routine stress testing improve outcomes in diabetic patients with prior revascularization?Goals:We aimed to perform a systematic review and meta-analysis of studies that evaluated death, MACE and repeated revascularization episodes in diabetic patients who have prior coronary intervention.Methods:We searched PubMed, Embase and Cochrane databases for randomized controlled trials (RCT) and cohort studies evaluating diabetic patients who underwent cardiac revascularization and reporting the following outcomes: (1) Myocardial Infarction (MI) and Cardiovascular Death; (2) Ischemia; and (3) Repeat Revascularization. Statistical analysis was performed using Open Meta and heterogeneity was assessed with I2statistical.Results:We included 16924 patients from 16 studies, of which 15 were observational cohort studies and 1 was a RCT. All patients were diabetics and had a history of revascularization. Follow-up ranged from 1 to 5.2 years. The mean patient age was 60.8±9.5 years and 75% were male. MI and cardiovascular death was found in 9.8% (95% CI; range 6.8-12.8%; p

Circulation, Volume 150, Issue Suppl_1, Page A4124585-A4124585, November 12, 2024. Introduction/Background:Low-value care is defined as care where harms or costs outweigh patient benefits. Prior studies have suggested that approximately 1 of every 10 carotid ultrasound tests are low-value because they were performed among patients without neurologic symptoms or a history of stroke. However, these studies have used administrative claims data that may not account for all patient symptoms or include all guideline-recommended indications. We assessed the validity of a claims-based measure of low-value carotid ultrasound testing compared to a reference standard of chart review.Hypothesis:Claims-based measures overestimate the proportion of carotid ultrasound tests classified as low-value care.Methods:We conducted a retrospective cohort study of Medicare fee-for-service beneficiaries attributed to an accountable care organization with administrative claims data linked to electronic health record data. Using Current Procedural Technology codes, the first 150 patients that underwent carotid ultrasound in 2021 were identified. We applied a claims-based algorithm used by researchers and policymakers to identify if testing was low-value or appropriate. We used linked electronic health record data to assess appropriateness of testing using the 2012 American Heart Association clinical practice guidelines. We assessed agreement between claims and chart review using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and Cohen’s Kappa.Results:Among 150 patients (mean age 76, 55% male, 86% white) who underwent carotid ultrasound, 76 tests (51%) were considered low value by the claims measure and 63 (42%) by chart review. Claims based measures were 67% sensitive, 61% specific, with a PPV of 55% and NPV of 62%. Cohen’s Kappa coefficient was 0.27 (CI 0.11 – 0.42), indicating only fair agreement between claims and chart review.Conclusion:We found that an often-used claims-based measure to identify low-value carotid ultrasound testing misclassifies a substantial proportion of tests as low-value. Using claims-based measures alone for assessing provider quality and making payment decisions could harm provider reputations and erode trust in the quality reporting system.

Circulation, Volume 150, Issue Suppl_1, Page A4134878-A4134878, November 12, 2024. Background:Vascular Closure utilizing Suture Based Devices (SBD) is an established approach for large-bore arterial access in percutaneous procedure patients. Standard of care uses two devices when accessing the artery with 8 Fr sheaths and above. The bailout use of Plug-based devices (PBD) is well established, but little is known about the intentional combination of SBD with PBD and how this technique compares to the standard approach. We aimed to compare these different approaches in this meta-analysis.Methods:PubMed, Scopus, and Cochrane databases were searched for observational studies comparing the hybrid approach to the standard one utilizing exclusively SBDs for arterial closure in large bore vascular access and reported the outcomes of (1) Access-related complications (ARC); (2) Major bleeding; (3) All bleeding events; (4) Need for surgical intervention; (5) Need for endovascular intervention ; (6) Device failure; (7) Pseudoaneurysm. Heterogeneity was examined with I2 statistics. A random-effects model was used for all outcomes.Results:We included five observational studies with 1,586 patients, of whom 1,489 (93.8%) underwent TAVI and 97 (6.1%) EVAR. Sheath size had an average of 20.56 Fr in the EVAR patients. ARC (RR 0.48; 95% CI 0.28-0.81; p

Circulation, Volume 150, Issue Suppl_1, Page A4144267-A4144267, November 12, 2024. Background:Percutaneous coronary intervention (PCI) is considered procedure of choice in patients with acute coronary syndrome (ACS). However, whether outcomes of PCI differ by sex remains uncertain.Hypothesis:This systematic review and meta-analysis aims to evaluate potential sex-related differences in major adverse cardiovascular events (MACE) after PCI among ACS patients in different timeframes.Methods:We conducted a systematic search of Pubmed, Embase, Cochrane, and ClinicalTrials databases to identify relevant randomized controlled trials with ACS patients undergoing PCI. The primary outcome of our article was study defined MACE components (all-cause mortality, cardiovascular mortality, myocardial infarction (MI), stroke, and need for revascularization). We evaluated Our outcomes in different timeframes, short-term (within 1 month after PCI), mid-term (1 month to 1 year), and long-term ( >1 year). We used a random-effects model to estimate risk ratios (RR) and 95% confidence intervals (CI). Egger’s test and funnel plots were used to assess publication bias.Results:Among 32 trials (78,846 patients; 59,491 men and 19,355 women), at short-term, PCI was associated with higher risk of all-cause mortality (RR=2.51, 95% CI 1.70; 3.71), MI (RR=1.33, 95% CI 1.00; 1.77), and stroke (RR=4.35, 95% CI 1.35; 14.04) in women compared with men. Concerning mid-term outcomes, the male group exhibited significantly lower risk of all-cause mortality, cardiovascular mortality, MI, and stroke compared to women group (RR=1.44, 95% CI 1.21; 1.72), (RR=1.29, 95% CI 1.00; 1.66), (RR=1.16, 95% CI 1.04; 1.28), and (RR=1.49, 95% CI 1.15; 1.93), respectively. Eventually, In the long-term, women were found to have a higher risk of both all-cause mortality (RR=1.27, 95% CI 1.16; 1.40) and cardiovascular mortality (RR=1.26, 95% CI 1.08; 1.48) compared to men. However, in terms of the need for revascularization, men had a higher risk compared to women (RR=0.87, 95% CI 0.77; 0.98).Conclusion:In the meta-analysis of PCI related trials in ACS patients, women have a higher risk of cardiovascular events compared to men in different timeframes.

Circulation, Volume 150, Issue Suppl_1, Page A4140674-A4140674, November 12, 2024. Background:Left atrial appendage occlusion (LAAO) and catheter ablation (CA) for atrial fibrillation (AF) have been increasingly performed in combination. However, the effects of this combined procedure remain unknown.Hypothesis:Combined LAAO and CA improves outcomes of patients with AF relative to isolated LAAO.Aims:To compare the outcomes of combined LAAO and CA with isolated LAAO in patients with AF.Methods:PubMed, Embase, and Cochrane Library were systematically searched from inception to March 2024 to identify studies comparing combined LAAO and CA versus isolated LAAO. We pooled odds ratios (OR) with 95% confidence intervals (CI) for binary endpoints. Statistical analyses were performed using R software version 4.3.1.Results:We included eight retrospective studies comprising 51,802 patients, of whom 1,375 (2.6%) received the combined procedure, and 29,696 (57.3%) were men. Mean age of patients ranged from 63.6 to 71.4 years. Follow-up ranged from 1 to 37.6 months. Additionally, 626 (1.2%) patients had paroxysmal AF and 757 (1.4%) had persistent AF. There were no significant differences between the combined procedure and LAAO alone in terms of major bleeding (OR 0.55; 95% CI 0.09 to 3.41; p=0.52; Figure 1A), stroke (OR 1.03; 95% CI 0.35 to 3.00; p=0.96; Figure 1B), or pericardial effusion (OR 1.18; 95% CI 0.60 to 2.33; p=0.63; Figure 1C).Conclusion:In this meta-analysis, there were no significant differences in major bleeding, stroke, or pericardial effusion when comparing combined LAAO and CA with isolated LAAO.

Circulation, Volume 150, Issue Suppl_1, Page A4145313-A4145313, November 12, 2024. Background:Transcatheter aortic valve replacement (TAVR) has become the primary treatment for severe aortic stenosis, surpassing surgery in multiple trials. However, there is limited evidence between self-expandable valves (SEV) and balloon-expandable valves (BEV). Therefore, we performed a systematic review and meta-analysis comparing the efficacy of SEV and BEV undergoing TAVR in severe aortic stenosis patients.Methods:We systematically searched Pubmed, Cochrane, and Embase for randomized controlled trials (RCTs) comparing SEV and BEV in patients with severe aortic stenosis. Our primary endpoint was (1) All-cause mortality. Additionally, we reported the following secondary outcomes:(2) stroke, (3)all-cause mortality within 30 days, and (4) stroke within 30 days. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled across studies using a random-effects model.Results:Our meta-analysis included six RCTs comprising 3488 patients, of whom 1617 subjects (46.3%) underwent SEV. The mean age was 81 years, and the mean follow-up was 2 years. In the pooled analysis, our results show no significant difference in all-cause mortality (RR: 0.95; CI 95%: 0.81,1.12; p= 0.56; Fig. 1A ) and stroke (RR:0.97; CI 95%: 0.72,1.32; p= 0.86; Fig. 2A) between SEV and BEV in patients with severe aortic stenosis undergoing TAVR. Our 30 days follow-up analysis also showed no significant change in all-cause mortality (RR: 1.74; CI 95%: 0.88,3.45; p= 0.11; Fig. 1B) and stroke (RR: 0.59; CI 95%: 0.17,1.98; p= 0.39; Fig. 2B).Conclusion:In this meta-analysis comparing SEV versus BEV in patients undergoing TAVR in patients with severe aortic stenosis, there was no significant difference between all-cause mortality and stroke. These findings were consistent in our 30-day follow-up subanalysis.