Risultati per: Progressi nel trattamento della psoriasi: review

Circulation, Volume 150, Issue Suppl_1, Page A4144394-A4144394, November 12, 2024. Introduction:Cardiac resynchronization therapy (CRT) reduces mortality in patients with moderate to severe heart failure (HF) and reduced ejection fraction. However, outcomes associated with CRT in CCC patients are still controversial. We conducted a meta-analysis to quantify total mortality in patients with chronic Chagas cardiomyopathy compared to HF of other etiologies (Non-Chagas).Objectives:To perform a meta-analysis of studies to measure all-cause mortality in CCC patients compared to patients of other etiologies (Non-Chagas) when undergoing CRT.Methods:A literature search was conducted in PubMed, Cochrane, Embase, Scielo for English, Portuguese, and Spanish comparing all-cause mortality in patients undergoing CRT in CCC and other etiologies (Non-Chagas). The Non-Chagas group included patients with HF of ischemic, dilated, or idiopathic etiology. Statistical analysis was performed in RevMan 5.18. Heterogeneity was assessed by I2 statistics.Results:577 patients from 3 studies were included, with 170 patients having Chronic Chagas Cardiomyopathy. Follow-up time ranged from 12 to 41 months. Mean age was 61.7 +/- 11.6 years and 61.5% were male. Mean ejection fraction across studies was 25.8% +/- 6.4.All-cause mortality (OR: 2.41; 95% CI: 1.65-3.53; p < 0.00001, I2 = 0%) was significantly higher in patients with Chronic Chagas Cardiomyopathy compared to the Non-Chagas group.Conclusion:Patients with CCC had higher all-cause mortality compared to Non-Chagas patients when undergoing CRT. These results highlight the importance of prospective controlled studies comparing Cardiac Resynchronization Therapy with other treatments to define the optimal therapy for patients with heart failure with reduced ejection fraction due to Chagas disease.

Circulation, Volume 150, Issue Suppl_1, Page A4147426-A4147426, November 12, 2024. Background:Calcified left main disease is a high-risk and procedurally complex subset of coronary artery disease. So, adequate lesion preparation before stenting is crucial in achieving a favorable outcome. We performed a meta-analysis to compare the safety of intravascular lithotripsy (IVL) and rotational atherectomy (RA) in preparation of calcified left main coronary artery disease.Hypothesis:We hypothesize that there are no significant differences in angiographic and in-hospital outcomes between RA and IVL while treating calcified left main coronary disease.Methods:We systematically searched PubMed, Embase, and Cochrane databases until May 2024 for studies comparing IVL and RA in calcified left main coronary disease. A random-effects model was used to pool risk ratios (RR) with corresponding 95% confidence intervals (CI). Statistical analyses were performed using software R and heterogeneity was assessed using I2statistics.Results:We included 3 studies comprising 276 patients undergoing PCI for calcified left main disease, of whom 109 (39.5%) underwent lesion preparation with IVL. The mean age was 72.9 years and 73.1% were males. In the pooled analysis, there were no significant differences between the IVL and RA treated groups in terms of in-hospital mortality (RR 0.30; 95% CI 0.08 to 1.13, p=0.07, I2=0%; Figure 1A) and in-hospital myocardial infarction (RR 0.85; 95% CI 0.17 to 4.11, p=0.83, I2=0%; Figure 1B). There was also no significant difference in angiographic outcomes such as coronary perforation (RR 0.56; 95% CI 0.15 to 2.04; p=0.37, I2=0%; Figure 2A) and slow-flow/no-reflow (RR 1.43; 95% CI 0.22 to 9.51; p=0.70, I2=0%; Figure 2B).Conclusion:This meta-analysis showed that both IVL and RA were comparable in terms of in-hospital and angiographic outcomes while treating calcified left main coronary disease.

Circulation, Volume 150, Issue Suppl_1, Page A4145308-A4145308, November 12, 2024. Background:Cardiogenic shock is a leading cause of mortality in acute myocardial infarction. The efficacy of mechanical circulatory support devices in reducing mortality is uncertain.Research Question:Which mechanical circulatory support device is associated with lower mortality and better safety outcomes in patients with cardiogenic shock?Goals/Aims:To compare different mechanical circulatory support devices in patients with cardiogenic shock.Methods:We conducted a systematic search of PubMed, Embase, and Cochrane Library databases up to April 2024 for randomized controlled trials (RCTs) involving mechanical circulatory support devices (e.g., Impella, ECMO, IABP, percutaneous ventricular assist device) reporting at least 30-day mortality or safety outcomes (bleeding, cerebrovascular events, sepsis). Two reviewers independently extracted data on mortality and safety outcomes. A frequentist network meta-analysis with random-effects models was used, calculating risk ratios (RR) with 95% confidence intervals (CI) and treatment ranking probabilities (P-SCORE).Results:Our systematic review and network meta-analysis included 15 RCTs, involving 1,927 patients, comprised of 77.6% of males with a mean age of 63.1 years, from Europe, North America, and Asia. No device reduced 30-day mortality. IABP had a lower risk of bleeding compared with Impella (RR 0.34; 95% CI 0.17-0.7), while ECMO had a higher bleeding risk compared with no support (RR 1.97; 95% CI 1.18-3.28). Regarding long-term mortality (30 + 180 days), ECMO showed a higher risk compared with Impella (RR 1.22; 95% CI 1.01-1.46). IABP led to fewer cerebrovascular events (RR 0.37; 95% CI 0.15-0.93) and sepsis (RR 0.54; 95% CI 0.35-0.83) compared with Impella. No significant differences were found in other comparisons.Conclusion:No mechanical circulatory support device significantly reduced 30-day mortality in patients with cardiogenic shock. IABP was associated with lower risks of bleeding, cerebrovascular events, and sepsis compared with Impella. ECMO showed a higher risk of bleeding compared with no support and higher long-term mortality compared with Impella. Further research should focus on identifying safer strategies and optimal patient profiles for these devices to improve outcomes.

Circulation, Volume 150, Issue Suppl_1, Page A4141290-A4141290, November 12, 2024. Background:Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality worldwide, with prompt defibrillation being crucial for improving survival rates. Public access defibrillators (PADs) offer a means for rapid intervention outside hospital settings. This systematic review evaluates the effectiveness of PADs in OHCA scenarios.Method:A systematic review was conducted following PRISMA guidelines. Global studies from 2000 onwards assessing bystander and emergency medical service (EMS) interventions during OHCA, particularly focusing on AED usage, were included. Data synthesis and quality assessment were performed using established frameworks, including Covidence for screening and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) framework for risk of bias assessment.Results:Thirty studies met inclusion criteria. PAD deployment significantly improved survival outcomes, with better results observed in public settings compared to private residences. Bystander-initiated defibrillation correlated with higher survival rates and improved neurological outcomes. School and airport settings demonstrated particularly favorable outcomes due to AED accessibility and trained personnel. The combination of CPR and AED use by bystanders markedly increased survival chances compared to EMS intervention. The difference in survival rates between bystander-initiated defibrillation and EMS intervention ranged from 5% to 42%. Regarding neurological outcomes, the difference between bystander-initiated defibrillation and EMS intervention ranged from 16.4% to 34%.Discussion:The review underscores the critical role of immediate bystander response and PAD accessibility in OHCA survival. Strategic AED placement in high-risk areas and widespread CPR training are essential for enhancing outcomes. Challenges include variable data collection methods and limited benefits in certain OHCA scenarios.Conclusion:Bystander interventions, including CPR and AED usage, significantly increase OHCA survival rates. Promoting widespread CPR training, strategic AED placement, and continuous outcome monitoring are vital for improving OHCA outcomes. Further research is warranted to address challenges and optimize intervention strategies.

Circulation, Volume 150, Issue Suppl_1, Page A4144167-A4144167, November 12, 2024. Background:Myocardial ischemia remains a significant global health concern for cardiovascular morbidity and mortality. In addition to the traditional treatment modalities, stem cell transplantation is emerging as a promising therapeutic intervention for cardiac regeneration and functional recovery. Our study evaluated the efficacy and clinical impact of SCT by reducing infarct scar size and improving cardiac function. The secondary objectives are to compare stem cell types, identify optimal transplantation strategies, and address safety and feasibility.Method:Randomized controlled trials from January 2000 to July 2023 were collected from PubMed, Cochrane, Google Scholar, and Elsevier. Based on criteria and evidence quality, screening and selection were done. A RevMan analysis was done. Infarct size, LVEF, LVESV, LVEDV, and mortality were measured. Comparator variables included placebo, medical therapy, CABG, and other types of stem cells. Randomization, allocation concealment, blinding, and therapeutic interventions differed among trials. Heterogeneity and publication bias were assessed using random-effects model and funnel plots. Sensitivity analysis and meta-regression identified outcome variability.Results:Seventeen studies (n = 1022 patients) met the inclusion criteria, encompassing various cell types, doses, and administration routes. Compared to controls, SCT greatly enhanced LVEF (MD: 3.39, 95% CI: 1.05 to 5.73, p = 0.005) and reduced infarct size (MD: 14.23, 95% CI: 7.12 to 21.35, p

Circulation, Volume 150, Issue Suppl_1, Page A4137019-A4137019, November 12, 2024. Background:Despite the effectiveness of drug-eluting stents (DES) in preventing restenosis, many patients still experience DES restenosis. Neointimal hyperplasia and neoatherosclerosis can develop within these stents, leading to recurrent coronary syndromes.Hypothesis:Repeated stenting with DES is limited by additional metal layers, the need for prolonged dual antiplatelet therapy, and heightened risks of stent thrombosis. Locally acting drugs with sustained efficacy may prevent this progression. Paclitaxel delivery via contrast medium or drug-coated balloon catheters could exert antiproliferative effects, reducing neointimal proliferation.Aims:To synthesize existing evidence on the efficacy and safety of Paclitaxel-Coated Balloons versus Uncoated Balloons in coronary in-stent restenosis.Methods:Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched five electronic databases (PubMed, EMBASE, Cochrane Library, Scopus, and Web of Science) to identify eligible studies reported up to March 23, 2024. Using R version 4.4.0, we reported outcomes as risk ratios (RRs) or mean differences (MD) and confidence intervals (CIs). This review has been registered and published in PROSPERO (CRD42024527412).Results:The meta-analysis included a total of six trials with 1,541 patients. PCB significantly reduced the incidence of myocardial infarction (RR 0.65, 95% CI [0.42, 1.00], p = 0.052), stent thrombosis (RR 0.26, 95% CI 0.08, to 0.83], p = 0.023), major adverse cardiac events (RR 0.32, 95% CI 0.25, to 0.42], P < 0.001), target lesion revascularization (RR 0.34, 95% CI [0.14, 0.84], p < 0.001). No significant differences were observed between PCB and UCB regarding cardiac-related mortality, target vessel revascularization, percutaneous coronary intervention, all-cause death, Q wave and non-Q wave myocardial infarction, coronary artery bypass grafting, and target vessel failure.Conclusion:PCB for ISR significantly reduced the incidence of myocardial infarction, MACE, and stent thrombosis compared to UCB.

Circulation, Volume 150, Issue Suppl_1, Page A4138494-A4138494, November 12, 2024. Introduction/Background:Hypertension is a leading cause of morbidity and mortality. Despite treatment recommendations and encouragement of lifestyle changes, the actual rate of blood pressure control is still not at par. Remote intervention methods have been shown to achieve better rates of blood pressure control utilising lesser resources and lower healthcare costs. We conducted a systematic review by qualitatively evaluating the potential impact of remote monitoring and interventions compared to usual care in controlling Hypertension.Research Question:Are remote monitoring techniques and interventions better than usual in-person blood pressure checks for hypertension control?Methods:We did a comprehensive literature search of Pubmed/MEDLINE, Google scholar, Cochrane central Library, PLOS ONE, ScienceDirect and Clinicaltrials.gov to identify eligible randomised control trials and clinical trials published between July 2013 and May 2025. A Risk of Bias assessment was conducted using Cochrane Risk of Bias tools such as ROB-2 for randomised control trials and ROBINS-1 for cohort studies. This study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Results:Of the 5,185 records analysed, 10 randomised control trials, 1 cohort study and 1 implementation study satisfied our inclusion criteria. Compared to usual care, remote monitoring methods showed significant difference in systolic blood pressure control at 6-12 months in 9 out of 12 studies, while 3 studies did not show any significant difference. Quality of life, physical health, mental health and drug compliance have also shown a significant positive difference in patients. Remote self monitoring interventions were found to be more cost-effective than usual care. They also reduced the load of patients seeking appointments for hypertension control thereby improving the quality of patient care.Conclusion:The management of clinical hypertension is a challenging entity. Conventional methods of regular in-office blood pressure checks are both tedious and resource consuming. Using remote monitoring methods have shown to significantly improve blood pressure control compared to routine methods. It also eliminates white-coat hypertension during follow-up blood pressure checks which leads to more appropriate interventions. Remote monitoring and intervention for hypertension control is time-effective, cost-effective and improves quality of life.

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 A4125729-A4125729, November 12, 2024. Background:Transcatheter edge-to-edge mitral valve repair (TEER) is an established procedure in patients with severe mitral regurgitation (MR) and elevated surgical risk on optimal medical therapy. However, there remains considerable mortality in this patient population. Some studies have shown that serum brain natriuretic peptide (BNP) and N-terminal pro b-type natriuretic peptide (NT-proBNP) predict all-cause mortality after TEER, whereas other studies have shown mortality to be independent of these markers. To address this gap in knowledge, we sought to examine the existing literature to determine whether there is an association between pre-procedural serum natriuretic peptides and mortality after TEER.Hypothesis:Among patients undergoing TEER, elevated pre-procedural BNP and NT-proBNP are associated with increased all-cause mortality.Methods:Databases including MEDLINE, Embase, and Cochrane Library were searched from inception through September 2023 for studies assessing pre-procedural serum natriuretic peptide levels and mortality among patients undergoing TEER. Pooled hazard ratios (HR) and standardized mean differences (SMD) were calculated using a random-effects model estimated by restricted maximum likelihood with the Hartung-Knapp modification.Results:A total of 30 studies comprising 10259 patients undergoing TEER met inclusion criteria. 25 studies measured NT-proBNP and 5 studies measured BNP. Elevated pre-procedural NT-proBNP ( >5000 or >10000 pg/mL) was associated with increased all-cause mortality in both adjusted (HR = 2.94; 95% CI = 1.75 – 4.95; I2 = 46.8%) and unadjusted (HR = 5.16; 95% CI = 1.85 – 14.40; I2 = 0.0%) analyses (Figures 1 and 2). Pre-procedural BNP and NT-proBNP were also significantly lower among survivors at 12 months compared to non-survivors (SMD = 0.82; 95% CI = 0.37 – 1.27; I2 = 78.3%) (Figure 3). This association was demonstrated in patients with primary or secondary MR.Conclusions:Pre-procedural BNP and NT-proBNP levels are significant predictors of all-cause mortality in patients undergoing TEER for primary or secondary MR. This supports the inclusion of BNP or NT-proBNP in pre-procedural assessments to help inform patient discussions and guide post-procedural follow-up and monitoring.

Circulation, Volume 150, Issue Suppl_1, Page A4117438-A4117438, November 12, 2024. Introduction:Transcatheter Mitral Valve Edge to Edge Repair (TEER) is an established percutaneous treatment for patients with severe symptomatic Mitral Regurgitation (MR). The current AHA/ACC guidelines recommend TEER for inoperable patients with severe primary MR or patients with symptomatic severe secondary MR despite medical therapy. Machine learning (ML) has emerged as a tool for TEER risk stratification due to the paucity of established risk scores. To address the lack of consensus on its efficacy, we conducted a systematic review and meta-analysis of studies that utilized ML to predict the success of TEER.Methods:Electronic databases, including Embase, MEDLINE, and the Cochrane Library, were searched from inception through April 2024. We included studies that used TEER and employed at least one ML model to predict the success of TEER. The Area Under the Receiver Operating Characteristic Curve (AUC) was used to measure the accuracy of ML risk stratification algorithms.Results:102 publications were screened, with seven eventually included in this analysis. Two studies employed clustering techniques, two utilized extreme gradient boosting, and three used multiple ML algorithms to predict outcomes. Of the four studies that compared the accuracy of ML with traditional Cox regression, all four demonstrated higher accuracy with ML, and this difference was statistically significant in three of the four studies. The mean AUC of the aggregated ML data was 0.737 [95% CI: 0.717, 0.758], compared to 0.627 [95% CI: 0.600, 0.653] for the pooled traditional methods.Conclusions:To our knowledge, we conducted the first systematic review and meta-analysis of ML methods for prediction of TEER success. ML outperformed established risk scores, demonstrating promising potential. Future ML models, trained on larger patient datasets, may further improve predictive accuracy in this patient population.

Circulation, Volume 150, Issue Suppl_1, Page A4143963-A4143963, November 12, 2024. Background:Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are known to have cardioprotective effects in diabetes mellitus and heart failure patients. Anthracyclines, chemotherapeutic agents used in the treatment of various malignancies, carry a high risk of cardiotoxicity and heart failure. The use of SGLT2i to prevent cardiotoxicity and adverse cardiovascular outcomes in cancer patients undergoing anthracycline therapy is not well established.Hypothesis:This meta-analysis aims to evaluate the relationship between the use of SGLT2i for the reduction of adverse cardiovascular outcomes in patients undergoing anthracycline therapy.Methods:We systematically searched for relevant articles published until March 2024 on PubMed, Cochrane, and Embase. The hazard ratio (HR) was pooled using the random-effects model and a p-value of

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 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.

Circulation, Volume 150, Issue Suppl_1, Page A4117397-A4117397, November 12, 2024. Background:Diabetes Mellitus (DM) significantly impacts global health through cardiovascular and renal complications. SGLT2 inhibitors (SGLT2i) have emerged as beneficial for cardiovascular outcomes in Type 2 Diabetes Mellitus (T2DM). However, only few studies report outcomes related to renal function.Aim:This study aims to analyse the efficacy of SGLT2i on cardiorenal outcomes in adults with T2DM.Methods:A systematic review and meta-analysis, following PRISMA-2020 guidelines was conducted. We evaluated the efficacy of SGLT2i on cardiorenal outcomes in adults with T2DM. We included randomized controlled trials(RCT) and post hoc analyses that compared SGLT2i with placebo, focusing on cardiovascular mortality, nonfatal myocardial infarction, nonfatal stroke, heart failure hospitalizations, and renal outcomes such as the progression of albuminuria and the decline of eGFR. Dichotomous outcomes were calculated using relative risk (RR) with 95% confidence interval (CI).Results:We identified 2753 studies, registered in PubMed(=788), Embase(n=538), WoS(n=369), Scopus(n=908), and Cochrane(n=150). We included 11 studies 6 RCT and 7 Post Hoc Analysis, sample size of 50.653 patients. Meta-analysis showed that SGLT2i improve cardiovascular outcomes such as reduced cardiovascular mortality (RR 0.84 [95% CI 0.73–0.97] p=0.02), heart failure hospitalizations (RR 0.65 [95%CI 0.54–0.77]p

Circulation, Volume 150, Issue Suppl_1, Page A4140600-A4140600, November 12, 2024. Background:Patients with nonvalvular atrial fibrillation (AF) and a history of intracranial bleeding while on anticoagulant therapy commonly undergo left atrial appendage occlusion (LAAO) to prevent thromboembolic events. Despite being suitable candidates for LAAO, treatment for this patient population is underrepresented in clinical trials.Methods:PubMed, Cochrane, and Embase databases were systematically searched for studies reporting clinical outcomes after LAAO in patients with prior intracranial bleeding. Pooled incidence data were presented as mean percentages with 95% confidence intervals (CI) using a random-effects model.Results:A total of 20 observational studies were included comprising 1,945 patients with nonvalvular AF and prior intracranial bleeding receiving LAAO. The mean age was 73.2 years, 35.2% were women, 49.8% received Watchman device. The mean CHA2DS2-VASc was 4.48 and the mean HAS-BLED was 3.74. In patients with prior intracranial bleeding, the LAAO procedure was associated with an all-cause mortality pooled incidence rate of 4.42% (95% CI 2.40-8.02; I2=81%, Figure 1A), major bleeding rate of 3.93% (95% CI 2.43-6.30; I2=54%, Figure 1B), device-related thrombosis rate of 1.46% (95% CI 0.83-2.66; I2=0%), peri device leak rate of 4.70% (95% CI 1.61-12.97; I2=86%), and stroke rate of 3.48% (95% CI 2.14-5.63; I2=47%).Conclusion:This meta-analysis of 20 studies found that, in patients with history of intracranial bleeding receiving LAAO, the incidence of clinical outcomes is comparable to the overall population undergoing LAAO.

Circulation, Volume 150, Issue Suppl_1, Page A4142243-A4142243, November 12, 2024. Background:The cumulative exposure to X-ray radiation during cardiac intervention can indeed pose various health risks. This meta-analysis aims to compare radiation protective shields (drapes and X-ray shields) versus conventional safety measures (lead apron) on the operator’s procedural radiation exposure during cardiac interventions.Methods:A systematic review and meta-analysis of randomized controlled trials (RCTs) from PubMed, Embase Cochrane, Scopus, and WOS until February 2024. We used the random-effects model to report continuous outcomes using mean difference (MD) with a 95% confidence interval (CI).Results:We included 16 RCTs with 3370 patients. Radiation shields were significantly associated with low total operator radiation dose (MD: -7.3, 95%CI [-11.9, -2.7], P< 0.01) with no significant difference between both arms regarding chest radiation dose (MD: -20.7, 95%CI [-48.9, 7.6], P= 0.15) and thyroid radiation dose (MD: -15.4, 95%CI [-32.4, 1.7], P= 0.08).Also, shields were significantly associated with low air kerma (MD: -46.4, 95%CI [-87.3, -5.5], P= 0.03) and low fluoroscopy duration (MD: -0.3, 95%CI [-0.6, -0.04], P= 0.02). However, there was no difference between both arms regarding the total procedure time (MD: -0.7, 95%CI [-3.1, 1.6], P= 0.54), contrast volume (MD: -3.2, 95%CI [-10.2, 3.7], P= 0.36), and dose area product (MD: 628.4, 95% CI [-3466.9, 4723.8], P= 0.76). Also, we found no differences between drape and shields subgroups in all outcomes.Conclusion:Radiation protection shields significantly reduced the total radiation dose exposure and air kerma. Also, shields are associated with lower fluoroscopy duration, insignificant lower procedure time, and contrast volume.