Risultati per: Progressi nel trattamento della psoriasi: review

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 A4146606-A4146606, November 12, 2024. Background:Intracoronary measurement of fractional flow reserve (FFR) has demonstrated higher sensitivity and better negative predicative value in evaluation of coronary artery disease than visual/angiographic only evaluation. Nonetheless, there is profound lack of evidence in the available literature that discusses the rate of complications when utilizing FFR versus standard angiography.Research Question:Does FFR carry higher or lower risk of procedural complications when compared with standard angiography?Aim:Compare the risk of complications encountered in FFR guidance in comparison to angiography only.Methods:The following databases were searched; PubMed, SCOPUS, CENTRAL, Web of Science. The following keywords were used; ((Fractional flow reserve OR FFR) AND (Adverse effect OR Complication)). The studies were included if they compared Angiography-guided Percutaneous Coronary Intervention (PCI) and Fractional Flow Reserve (FFR)-guided PCI in terms of mortality or Major Adverse Cardiac Events (MACE). Case reports and series, animal studies, reviews and non-English articles were excluded from this study. The exposure of interest was FFR-guided PCI whereas the outcomes of interest were MACE and mortality.Results:A total of 1,822 articles were identified. After removing duplicates, initial screening, and secondary screening, 15 articles were included and the total number of included patients was 421,291. The percentage of patients who underwent FFR guidance was 3.5% whereas the rest underwent angiography only. Male predominance was noted in both, FFR and angiography. The mean age of the patients who underwent FFR and angiography was 64.9 ± 9.1 and 65.2 ± 9.3 years, respectively. The model that compared between angiography only and FFR in MACE (14 studies) showed that FFR was significantly associated with lower risk of MACE compared to angiography (RR=0.62, 95%CI:0.48-0.81); this model also showed significant heterogeneity (P-value

Circulation, Volume 150, Issue Suppl_1, Page A4147434-A4147434, November 12, 2024. Background:Tirofiban is a GP IIb/IIIa inhibitor, an anti-platelet drug that is used after ischemic episodes like stroke or acute coronary syndromes. We are assessing the safety and efficacy of the drug in patients who have suffered an acute ischemic stroke.Methods:A comprehensive search of PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov from inception to April 2024 yielded randomized controlled trials (RCTs) comparing Tirofiban and control in patients with acute ischemic stroke. We assessed the risk of bias using the revised Cochrane “Risk of bias” tool for randomized trials (RoB 2.0). We analyzed the outcomes using RevMan 5.4, with risk ratio (RR) as the effect measure.Results:A total of eight RCTs with 3678 patients were included in our meta-analysis. According to our meta-analysis, the Tirofiban group was associated with a statistically significant increase in the patients showing functional independence at 90 days, measured by patients with Modified Rankin Score (mRS) of 0-2 (RR 1.14; CI = 1.05-1.25; I2= 38%). We found no difference between the two groups regarding excellent outcome (mRS score 0-1) at 90 days (RR 1.15; CI = 0.99-1.33; I2= 51%) and mortality (RR 0.86; CI = 0.50-1.46; I2= 56%). The tirofiban group did not increase the incidence of both intracranial hemorrhage (ICH) (RR 1.23; CI = 1.04-1.46; I2= 0%) and symptomatic ICH (RR 1.41; CI = 0.93-2.14; I2= 0%).Conclusion:According to our analysis of acute ischemic stroke patients, Tirofiban increased the number of patients with functional independence with no increase in adverse events as compared to the control group. Large-scale RCTs are needed to better ascertain the role of Tirofiban in acute ischemic stroke.

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 A4116340-A4116340, November 12, 2024. Background:Transcatheter aortic valve replacement (TAVR) stands as a notable alternative to surgery for severe aortic stenosis (AS). Despite the established benefits of statins in cardiovascular pathologies, their specific impact in patients with severe AS undergoing TAVR remains uncertain. Our study aims to assess whether perioperative statin use improves survival and outcomes post-TAVR.Methods:A search was conducted across various databases to retrieve studies comparing perioperative statin use versus no statin use in patients undergoing TAVR. The primary outcome of interest was all-cause mortality (ACM). Secondary outcomes included stroke, acute kidney injury (AKI), 30-day mortality, myocardial infarction (MI), cardiovascular complications, and in-hospital mortality. Comprehensive Meta-Analysis Software (v. 3) was used to pool odds ratio (OR) under a random-effects model, with statistical significance set at p < 0.05.Results:Our analysis encompassing 20663 patients from 15 observational studies found that perioperative statin use was associated with a significant reduction in ACM (OR= 0.71, 95% CI: 0.61-0.83,I2= 50.3%, p

Circulation, Volume 150, Issue Suppl_1, Page A4145315-A4145315, November 12, 2024. BACKGROUND:Transgender and gender expansive (TGE) people constitute a vulnerable population with added cardiovascular risk and frequently experience health inequalities and obstacles to care. However, they are nonetheless underreported and underrepresented in clinical trials. We aim to understand inclusion and representation of TGE population in clinical research by examining the volume and caliber of reporting in certain disciplines of CV clinical trials.METHODS:A systematic review of clinical trials from January 2020 to March 2024 was conducted across 4 cardiovascular areas (heart failure, stroke, dyslipidemia, electrophysiology) using ClinicalTrials.gov focusing on the inclusion and reporting of TGE populations in the United States with published results. Trials were evaluated for explicit mention of TGE participants, use of gender-inclusive language, and provision of disaggregated data by gender identity. Equity metrics, such as the proportion of trials including TGE participants were calculated.RESULTS:A total of 32,583 participants were included(Table).We collected reporting of populations for sex and gender descriptions, as well as the inclusion and exclusion criteria. Almost all studies reported sex or gender as a single outcome variable. We inferred this to denote sex unless it was specified otherwise. All studies reported sex, with women representing 54% of all participants. Women represented the minority of study participants in stroke (39%), dyslipidemia (45%), and electrophysiology (37%) clinical trials, but majority of participants in heart failure trials (64%). Gender identity, including the option “other”, was reported in only 3 trials (4.1%), of which 2 were heart failure and 1 was a dyslipidemia trial. Most trials had pregnant women, lactating women, and age 18 years as the inclusion criteria.CONCLUSION:Our findings confirm that there is still a lack of commitment in current clinical trials to the Sex and Gender Equity in Research guidelines. The impact of the differences in this population can never be fully understood unless gender identification data is carefully gathered. Current national guidelines mandate that in randomized clinical trials, gender should be fully reported and that gender-inclusive language be used appropriately. To properly represent and care for these populations, future cardiology studies should adhere to the Sex and Gender Equity in Research principles.

Circulation, Volume 150, Issue Suppl_1, Page A4122080-A4122080, November 12, 2024. Introduction:The prevalence of non-valvular atrial fibrillation (NVAF) and stroke-related morbidity is rising. First-line therapy remains rate or rhythm control with anticoagulation, with catheter ablation (CA) also considered in suitable candidates. Left atrial appendage closure (LAAC) is increasingly used due to mounting evidence of non-inferiority compared to anticoagulation. Despite improved pre-procedural planning and patient selection reducing complications, adverse outcomes such as pericardial effusion and device-related thrombus occur in about 5% of patients. This study evaluates the outcomes of LAAC with CA versus standalone LAAC in NVAF patients with contraindications to anticoagulation.Methods:We searched PubMed, EMBASE, and Cochrane databases for all cohort studies comparing LAAC with CA to LAAC alone in patients with NVAF. Case series, reviews, and non-English language studies were excluded. The assessed outcomes included device compression rate at implant, device-related thrombosis, pericardial effusion, need for pericardiocentesis, and peri-device leak at 6 weeks. Statistical analysis was performed using Review Manager 5.1.7. Heterogeneity was assessed with I2statistics.Results:We included 6 studies with 51,545 patients, of whom 1,221 (2.3%) underwent both procedures. LAAC with CA and standalone LAAC cohorts had similar baseline demographics including age (68, 69 years), percentage of women (48%, 46%), CHA2DS2-VASc score (3.6, 3.7), and HAS-BLED score (3.1, 3.2). LAAC with CA was associated with a reduced incidence of device-related thrombosis (OR=0.18; 95% CI= 0.04-0.89; p=0.04) without an increase in pericardial effusion rates (OR=0.85; 95% CI= 0.48-1.51; p=0.59). There were no significant differences in device compression rates at implant (MD=0.34; 95% CI= -0.77-1.45; p=0.55), the need for pericardiocentesis (OR=1.01; 95% CI= 0.30-3.48; p=0.98), or rates of peri-device leak at 6 weeks (OR=0.61; 95% CI= 0.21-1.78; p=0.37).Conclusion:Concomitant LAAC with CA may reduce rates of device-related thrombosis compared to standalone LAAC without increasing the risk of pericardial effusion or peri-device leak at 6 weeks. These findings support the consideration of combining these procedures in the management of high-risk NVAF patients unable to tolerate anticoagulation.

Circulation, Volume 150, Issue Suppl_1, Page A4146173-A4146173, November 12, 2024. Background:Recurrent atrial fibrillation (AF) occurs in approximately 20 to 40% of patients following catheter ablation. SGLT2 inhibitors (SGLT2i), known for their cardiovascular benefits beyond glycemic control in type 2 diabetes, exhibit multiple pleiotropic effects. These effects offer glucose-independent and direct cardiac protection, potentially enhancing atrial remodeling. Studies suggest that SGLT2 inhibitors may also reduce atrial tachyarrhythmia and lower the risk of recurrence after the initial ablation procedure.Methods:We conducted a systematic review and meta-analysis following PRISMA guidelines. Studies were identified from three databases up to May 2024: MEDLINE/PubMed, Scopus, and the Cochrane Central Register of Controlled Trials. Primary outcomes included AF recurrence with secondary outcomes of left ventricular ejection fraction (LVEF) improvement, hospitalizations and adverse events. Data was extracted and analyzed using R/R Studio. Random effects model was utilized to calculate odds ratios (OR) and 95% confidence intervals (CI).Results:Six studies were included with 5,456 participants (2,514 in SGLT2i group, 2,942 in control group). SGLT2i significantly reduced AF recurrence (OR = 0.44, 95% CI: 0.29-0.67, I2= 65%, p = 0.01). Four studies with 1,044 participants showed a non-significant trend towards LVEF improvement with SGLT2i (OR = 1.99, 95% CI: 0.99-3.99, I2= 0%, p = 0.88). Hospitalization rates from five studies (5,184 participants) showed no significant difference between groups (OR = 1.07, 95% CI: 0.63-1.82, I2= 46%, p = 0.12). Adverse events in four studies (734 participants) were not significantly higher in the SGLT2i group (OR = 1.19, 95% CI: 0.56-2.52, I2= 0%, p = 0.53).Conclusions:The results suggest that SGLT2i use significantly reduces AF recurrence following catheter ablation, with a trend toward LVEF improvement, though not statistically significant. Hospitalization rates and adverse events did not significantly differ between the SGLT2i and control groups, indicating a favorable safety profile. These findings support the potential benefit of SGLT2i in post-ablation management. Further large-scale randomized controlled trials are needed to confirm these results.

Circulation, Volume 150, Issue Suppl_1, Page A4140556-A4140556, November 12, 2024. Background:Degarelix is a third-generation GnRH receptor antagonist approved for the treatment of prostate cancer. Recent data shows that the use of GnRH agonists is associated with higher cardiovascular morbidity and mortality and, suggesting the shorter time to testosterone suppression and lack of testosterone surge, GnRH antagonists might be more clinically beneficial.Purpose:We aimed to perform a meta-analysis comparing the cardiovascular disease risk between degarelix and gonadotropin-releasing hormone agonists in patients with all stages of prostate cancer.Methods:PubMed, Scopus and Web of Science databases were searched for randomized control trials (RCTs) and observational studies assessing the cardiovascular disease risk between degarelix and GnRH agonists in patients with prostate cancer. The outcomes of interest were (1) Cardiovascular Disease Risk, (2) Major Adverse Cardiovascular Events, (3) Stroke, (4) All-Cause Death, (5) Myocardial Infarction, (6) Heart Failure, (7) Arrhythmia, and (8) Hypertension. We computed binary endpoints risk ratio (RR) or hazard ratio (HR) with 95% confidence intervals (CI), which were analyzed using a random-effects model. Heterogeneity was examined with I2 statistics. P values of ≤ 0.05 were considered statistically significant. Statistical analyses were performed using RStudio, version 4.2.3.Results:8 RCTs and 7 observational studies were included (123,969 patients; mean age 75 years; 12 months follow-up). Degarelix was associated with a significantly lower incidence of major adverse cardiovascular events (10.30% degarelix vs. 31.01% GnRH agonists; RR 0.59; 95% CI 0.41, 0.84; p = 0.003; I2=84%). Incidence of stroke (1.04% degarelix vs. 2.56% GnRH agonists; RR 0.89; 95% CI 0.56, 1.42; p = 0.62; I2=0%), all-cause mortality (3.15% degarelix vs. 5.24% GnRH agonists; RR 0.64; 95% CI 0.37, 1.13; p = 0.12; I2=41%), hypertension (4.05% degarelix vs. 5.78% GnRH agonists; RR 0.71; 95% CI 0.48, 1.04; p = 0.08; I2=0%), myocardial infarction (HR 1.04; 95% CI 0.59, 1.84; p=0.86; I2=66%), heart failure (HR 0.79; 95% CI 0.38, 1.62; p=0.52; I2=79%) and arrhythmia (4.58% degarelix vs. 10.67% GnRH agonists; RR 0.63; 95% CI 0.28, 1.41; p = 0.86; I2=37%), did not reach a statistically significant difference between groups.Conclusion:In patients with prostate cancer, degarelix is associated with a significantly lower incidence of major adverse cardiovascular events.

Circulation, Volume 150, Issue Suppl_1, Page A4147186-A4147186, November 12, 2024. Background:Naples prognostic score (NPS) is a recently developed tool for assessing inflammatory and nutritional status. It is commonly used to evaluate cancer patients.Purpose:We aimed to investigate the impact of NPS on clinical outcomes in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI).Methods:We comprehensively searched PubMed, WOS, SCOPUS, EMBASE, and CENTRAL through June 2024. We conducted a systematic review and meta-analysis pooling dichotomous data using risk ratio (RR) with a 95% confidence interval (CI). All analyses were performed using R V. 4.3.1.Results:We included five studies with a total of 12,785 patients. Comparing high NPS (3-4) to low NPS (0-2), high NPS (3-4) was significantly associated with an increased incidence of overall mortality (RR: 2.21, 95% CI [1.85, 2.65], P < 0.01), shock (RR: 1.85, 95% CI [1.33, 2.57], P < 0.01), acute kidney injury (RR: 1.54, 95% CI [1.15, 2.08], P < 0.01), left ventricular thrombus (RR: 2.93, 95% CI [1.44, 5.94], P < 0.01), and no-reflow (RR: 1.35, 95% CI [1.17, 1.57], P < 0.01). However, there was no significant difference between high NPS (3-4) and low NPS (0-2) regarding in-hospital mortality (RR: 1.82, 95% CI [0.99, 3.37], P = 0.06).Conclusion:Our meta-analysis highlights the importance of evaluating inflammation and malnutrition status in STEMI and shows that routine blood tests can provide prognostic insights. NPS can help predict different clinical outcomes in STEMI patients undergoing PPCI. While it does not affect in-hospital mortality, its simplicity and accessibility make it useful for clinical risk assessment and long-term prognosis. Further studies are needed to investigate its predictive value further.

Circulation, Volume 150, Issue Suppl_1, Page A4135270-A4135270, November 12, 2024. Introduction:A growing body of evidence from randomized controlled trials (RCTs) has demonstrated the superiority of transcatheter aortic valve replacement (TAVR) over surgical aortic valve replacement (SAVR) irrespective of surgical risk in patients with severe aortic stenosis (SAS). Given the rise in TAVR procedures, analyzing trends in outcomes over time is critical to aid clinical decision-making. Hence, we pooled RCT data for a robust assessment of clinical and procedural outcomes in SAS patients undergoing TAVR and SAVR.Methods:PUBMED and SCOPUS were queried until April 2024. Trials were classified into high and low-risk groups based on surgical risk. The outcomes were analyzed at 30 days (short-term), 1 year (mid-term), and 5 years (long-term). Estimates were calculated as random effects risk ratios (RRs) with 95% confidence intervals (CI).Results:10 RCTs with a total of 10,252 patients were included. There was no significant association between TAVR and SAVR in reducing all-cause mortality at 30 days (RR: 0.84 [0.64, 1.10]; Figure 1a). While TAVR was associated with a significantly lower all-cause mortality at 1 year (RR: 0.82 [0.68-0.97]; Figure 1b), it was linked with a significantly higher all-cause mortality at 5 years (RR: 1.14 [1.07-1.21]; Figure 1c). Myocardial infarction and stroke were similar in both groups up to 5 years. TAVR was associated with a lower risk of acute kidney injury for up to 1 year and atrial fibrillation for up to 5 years but a higher risk of new permanent pacemaker implantation and aortic valve re-intervention for up to 5 years. In low-risk patients, TAVR showed no significant differences from SAVR for all-cause mortality at 30 days and 5 years, but it was significant at 1 year. In high-surgical-risk patients, all-cause mortality was comparable between TAVR AND SAVR at 30 days and 1 year, with a higher rate observed with TAVR at 5 years.Conclusion:Compared with SAVR, TAVR was superior in reducing all-cause mortality at 1 year in low-risk patients and inferior in reducing all-cause mortality at 5 years in high-risk patients. A thorough evaluation of anatomical, clinical, and procedural factors is crucial to tailor the optimal intervention for each patient.

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 A4144899-A4144899, November 12, 2024. Introduction:Non-ST elevation myocardial infarction (NSTEMI) significantly contributes to the burden of cardiovascular diseases, affecting millions of patients. The management of NSTEMI has evolved and it involves invasive and conservative strategies, the optimal management remains unclear. We conducted this systematic review and meta-analysis to compare the two different strategies and their long-term outcomes.Methods:We systematically examined the clinical outcomes of conservative and invasive management of patients with NSTEMI using medical records from Web of Science, PUBMED, Scopus, and Cochrane. Our outcomes of interest were all-cause mortality, myocardial infarction (MI), and major bleeding. Odds Ratios (OR) and 95% CI were used in a fixed-effect model to analyze the data.Results:Our study included 24 studies with a total of 1,076,572 patients. the invasive strategy was significantly associated with a reduction in all-cause mortality (OR: 0.52, 95% CI: 0.51 to 0.53), and the incidence of myocardial infarction (OR: 0.84, 95% CI: 0.73 to 0.97). However, the invasive strategy showed a significant increase in major bleeding events (OR: 1.93, 95% CI: 1.87 to 1.98).Conclusion:The invasive strategy showed better clinical outcomes on the long-term follow-up related to all-cause mortality and myocardial infarction, with an increase in the incidence of major bleeding events.

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 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.

Circulation, Volume 150, Issue Suppl_1, Page A4120966-A4120966, November 12, 2024. Background The development of in-stent restenosis (ISR) has emerged as a substantial barrier to interventional treatment for coronary heart disease. Drug-coated balloon (DCB) is an efficacious interventional technique for the management of ISR. This meta-analysis compares the efficacy of DCB in the treatment of ISR with that of an uncoated balloon (UCB). Methods We comprehensively searched literature on MEDLINE, Embase, Cochrane, and clinicaltrials.gov using MeSH terms and relevant keywords for “Balloon Angioplasty” and “in-stent Restenosis” from inception to June 1, 2024, followed by a meta-analysis of all randomized controlled trials (RCTs) to assess both strategies for treatment of ISR. Random effects model was used to aggregate the risk ratios (RR) for dichotomous and mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI). Results The search strategy retrieved 2330 studies. Duplicates and irrelevant articles were removed and data from seven RCTs (1,408 patients) was extracted. The mean age ranged from 64 to 74 years. The mean clinical follow-up ranged from 1 to 10 years. DCB was found to be superior to UCB at latest follow up in terms of target lesion revascularization (TLR) (RR 0.34, 95% CI 0.19-0.58; p 0.0001; I2 79%), major adverse cardiovascular events (MACE) (RR 0.41, 95% CI 0.23-0.73; p 0.003; I2 84%), late lumen loss (LLL) (MD -0.46 mm, 95% CI -0.64- -0.28]; p