Risultati per: LBP (Low Back Pain): Cosa dicono le linee guida del mal di schiena

Circulation, Volume 150, Issue Suppl_1, Page A4136984-A4136984, November 12, 2024. .Background:Third-degree atrioventricular block (AVB) is the most common manifestation of Anti-Ro antibody associated fetal cardiac disease. Extranodal findings of isolated cardiac echogenicity, valvulitis with insufficiency and AV interval prolongation have been reported but not described in large prospective series.Aims:To report the occurrence and outcomes of extranodal findings in subjects followed prospectively since 2020 in STOP BLOQ (Surveillance and Treatment to Prevent Fetal AV block Likely to Occur Quickly) and the Registry for Neonatal Lupus (RNL).Methods:We reviewed fetal echo reports from pregnant STOP BLOQ and RNL Anti-Ro antibody subjects. Pregnancies with high ( >1000 EU for anti-Ro52 or 60) antibody titers measured in a core research lab underwent surveillance with home fetal heart rate monitoring (FHRM) 3x/day and weekly or bi-weekly fetal echos from 17- 26 gestational weeks. Low titer subjects underwent echo or no surveillance based on local site protocol. We evaluated cardiac function, effusions, cardiac echogenicity and its location, any tricuspid (TV) or mitral (MV) insufficiency trivial or >trivial) and AV conduction times (170 ms)Results:Echo reports were available in 622 prospectively followed pregnancies (376 high (40/376 with a previously affected child) and 246 low-titer pregnancies. All had subjectively normal ventricular function and none had effusions. Seven fetuses, 2 low and 5 high titer at 19 (range 16.7-21.7) weeks demonstrated cardiac echogenicity (n=6), AV or semilunar valve insufficiency (n=2) or AV interval 150-170 ms (n=2) (Table). Subjects 1 and 2, both high titer and treated with prophylactic Plaquenil (400 mg/d before 10 gestational weeks), had prior fetal AVB. Subject #1 had normal AV conduction but MV and TV echogenicity and moderate insufficiency of both valves which resolved in days after IVIG and dexamethasone (dex) treatment, but 3° AVB developed at 19 weeks after dex wean. Subjects 2-7 received no treatment and extranodal findings did not progress to cardiac dysfunction or AVB. During the same time period, 10 high titer subjects developed 2° or 3° AVB.Conclusion:Anti-Ro associated extranodal findings are rare, occurring in 1% of pregnancies overall and in 5% of pregnancies with a previously affected child. Unlike AVB, extranodal findings can occur in low titer pregnancies. The role of treatment for isolated extranodal findings in the absence of cardiac dysfunction is unclear.

Circulation, Volume 150, Issue Suppl_1, Page A4136277-A4136277, November 12, 2024. Introduction:The most common acute coronary syndrome (ACS) symptom is chest pain. Chest pain is an umbrella term more precisely described using words like pressure or tightness. Previous studies have not explored the lay public’s conceptions of ACS-related chest pain. Misconceptions about chest pain make it difficult for individuals to recognize this symptom if they were to experience it, delaying care seeking.Research Question:How does the lay public conceive of ACS-related chest pain?Methods:Participants from across the U.S. were recruited in May and June 2023. Participants completed an online survey including the Chest Pain Conception Questionnaire. Descriptive statistics were used to characterize conceptions of chest pain quality, timing, intensity, and distress. Conceptions of men and women were compared using the independent-samplest-test and Chi-square test.Results:Participants (n=597) were mostly women (n=355; 59.5%) with a mean age of 54.0 years (SD = 11.5). The sample was diverse: White (n=414, 69.2%), Black (n=101; 16.9%), Hispanic or Latina/o/e/x (n=96; 16.1%), and Asian (n=67; 11.2%). Participants often thought of pressure (78.9%), tightness (77.4%), squeezing (75.5%), gripping (72.9%), and heaviness (72.5%) as possible descriptors of ACS-related chest pain. They less often thought of discomfort (48.7%), fullness (16.8%), and indigestion (13.4%). Participants expected ACS-related chest pain to be “intense” and to bother them “a lot,” both with median scores of 4.0 on a 5-point Likert scale. Participants felt that ACS-related chest pain would “often” (median 4.0) occur with activity and “sometimes” (median 3.0) occur at rest. Women were more likely to rate specific descriptors of chest pain (i.e., pressure, tightness) and general descriptors of chest pain (i.e., discomfort, pain) as more likely ACS-related chest pain descriptors than men, (allps≤ .05). Women (n=58; 16.3%) were about twice as likely as men (n=22; 9.2%) to endorse indigestion as a possible descriptor of ACS-related chest pain, (p= .013, OR = 0.52 [95% CI = 0.31-0.87]).Conclusions:As many as 1 in 5 participants did not endorse common descriptors such as pressure and tightness as potentially characterizing ACS-related chest pain. Most believed this symptom would be intense and bother them a lot. They also more often associated ACS-related chest pain with activity than with rest. Clinical and research interventions can target the misconceptions identified in this study.

Circulation, Volume 150, Issue Suppl_1, Page A4139307-A4139307, November 12, 2024. Introduction:Heart failure (HF) is associated with unique comorbidities and sequelae, which can affect clinical presentation and patient outcomes. This is specifically challenging when patients are evaluated for suspected acute coronary syndrome (ACS). We sought to compare the most important predictors of poor outcomes in patients with and without HF seen in the emergency department (ED) for ACS.Methods:This was a secondary analysis of a prospective observational cohort study of consecutive patients seen for symptoms suggestive of ACS, such as chest pain (CP) and dyspnea, in the EDs of three UPMC-affiliated tertiary care hospitals (NCT04237688, clinicaltrials.gov). Primary outcome was 30-day major adverse cardiac events (MACE), adjudicated by two independent reviewers. Clinical data were collected form charts and we used KNN to impute missing data for features, most of which had less than 12.5% missingness. For features with greater than 12.5% missingness (i.e., BNP, Mg), binary indicators were added to flag missing values. Data were normalized using the Euclidean norm. Two random forest (RF) classifiers were trained using 10-fold cross validation with 71 manually selected features available early in the ED course (i.e., vital signs, labs, past medical history, ECG), and tested on patients with and without known HF. Model performance was evaluated using AUROC, and top features were identified with SHAP values.Results:The sample included 2400 patients (age 59 ± 16 years; 47% female, 41% Black, 15.9% ACS), of whom 438 had HF (age 66 ± 14 years; 45% female, 49% Black, 15.1% ACS). Individuals with HF were more likely to experience MACE (38% vs 23%,p

Circulation, Volume 150, Issue Suppl_1, Page A4147079-A4147079, November 12, 2024. Introduction:Observational studies in heart failure (HF) patients have shown that low levels of the thyroid hormone triiodothyronine (T3) with otherwise normal thyroid testing (‘low T3 syndrome’) is a risk factor for adverse clinical outcomes. Preclinical studies have shown beneficial effects from T3 therapy on myocardial contractility, myocardial relaxation, and vascular resistance, but human studies are lacking.Research Question:In patients with HF and low T3 syndrome, is oral liothyronine (LT3) safe, and does it impact cardiovascular clinical and physiologic phenotypes?Aims:Primary aim: To evaluate the safety of oral LT3 therapy in HFrEF and HFpEF. Secondary aim: To evaluate the feasibility and preliminary efficacy of oral LT3 therapy in HFrEF and HFpEF.Methods:A total of 28 participants with HFrEF and 28 with HFpEF aged 18+ years enrolled in a single-center, randomized, double-blind, placebo-controlled, crossover trial and were prescribed LT3 or placebo for 8 weeks with a 2-week washout period. Primary outcomes were safety as assessed by T3 level; arrhythmic events by EKG, 14-day adhesive patch monitoring, and ICD (HFrEF only); and adverse events. Secondary efficacy outcomes included Kansas City Cardiomyopathy Questionnaire, NT-proBNP level, peak O2 consumption during a cardiopulmonary exercise test, and actigraphy. Secondary mechanistic outcomes included non-invasive assessments of cardiac and arterial function measured via echocardiography and arterial tonometry.Results:Low T3 syndrome was present in 20% of screened participants. After LT3 treatment, T3 levels markedly increased compared with placebo. Heart rate was higher on LT3 (mean difference 2.4 beats per minute, p

Circulation, Volume 150, Issue Suppl_1, Page A4143480-A4143480, November 12, 2024. Background:Social isolation and loneliness have been found to be associated with many chronic diseases including cardiovascular disease (CVD) and those with both CVD and social isolation may have a worse prognosis. Cardiac rehabilitation (CR) has been shown to improve outcomes following cardiac events. We hypothesize that CR may have beneficial impacts on quality of life, social support, depression, and pain rated via Dartmouth COOP Charts (COOP).Research Question:What is the impact of cardiac rehabilitation on quality of life, perceived social support, depression, and chronic pain?Methods:Data from Penn State Hershey Medical Center’s CR program was extracted pre-and post-CR, including Body Mass Index (BMI), Metabolic Equivalents (METs) performed, and components of COOP (social support, quality of life (QoL), depression, pain), with impairment rated from 1 to 5, with 5 representing worse impairment. Analysis was performed with paired t-test. Sensitivity analysis was performed including only high-risk participants (pre-rehab COOP score ≥ 3) for social support, depression, and pain as well as BMI ≥ 30 kg/m2.Results:A total of 743 participants were included with a mean (±SD) age of 66.3 (±11.3) years. CR improved METs performed, QoL, depression, and pain (Table 1). When analyzing all participants, CR did not improve social support or BMI. However, when only analyzing those with higher social support needs at baseline (n= 78) as well as elevated BMI ≥30kg/m2, CR was associated with improved social support and BMI. QoL, depression and pain also improved among the higher risk groups (Table 2).Conclusion:CR programs have demonstrated benefits for cardiovascular mortality and may have powerful impacts on patients’ mental health, pain, and social support. Further studies are needed to further elucidate the role CR may have in improving outcomes in participants with social isolation and loneliness.

Circulation, Volume 150, Issue Suppl_1, Page A4140003-A4140003, November 12, 2024. Background:Hypertension is a major preventable risk factor for cardiovascular (CV) disease. Emerging evidence suggests that in addition to blood pressure (BP) levels, controlling the consistency of BP is a key determinant of clinical outcomes. We aimed to assess the effects of consistency of BP control on adverse CV and renal outcomes using two metrics: long-term variability of systolic BP (LT-BPV) and the degree at which BP control is achieved, known as cumulative systolic BP load (CBPL).Methods:We collected clinic systolic BP (SBP) measurements from UK Biobank primary care records in those diagnosed with hypertension (N=39,816), chronic kidney disease (CKD, N=8,062), and neither of these (N=17,702), including a per-participant mean of 21 SBP values over 6 years. Instances of the primary outcome, 4-point major adverse cardiovascular events (MACE; stroke, acute myocardial infarction, heart failure hospitalization, and cardiovascular-related death), were collected from hospital records. Per-standard deviation (SD) and per-quartile hazard ratios (HR) were used to estimate LT-BPV, CBPL, and mean SBP separately using adjusted Cox regression. Sensitivity analyses were used to determine the independence of BP consistency effects from mean BP levels.Results:In those with hypertension, each per-SD increase in LT-BPV was associated with increased risk for MACE (HR=1.12, p=4.4E-11), specifically CV-related death, stroke, and HF hospitalization. LT-BPV effect estimates were strongest in those with controlled SBP and the strongest predictors for all events in those without high-risk comorbidities (coronary artery disease, CKD, peripheral vascular disease, and diabetes). CBPL was similarly associated with MACE (HR=1.13, p=8.1E-13), specifically stroke and acute myocardial infarction, but not with fatal events or HF. In those with CKD, both LT-BPV and CBPL were associated with progression to renal failure (HR=1.31-1.33, p

Circulation, Volume 150, Issue Suppl_1, Page A4140066-A4140066, November 12, 2024. Background:The no-reflow has been reported to be associated with larger infarct size and mortality after acute myocardial infarction (AMI). A pathological classification of no-reflow was proposed: structural no-reflow—microvessels within the necrotic myocardium exhibit loss of capillary integrity (it is usually irreversible)—and functional no reflow—patency of microvasculature is compromised due to distal embolization, spasm, ischemic injury, reperfusion injury. It may be reversible. After about 6 hours of AMI, myocardial necrosis occurs, which leads to the coronary microcirculation to injury which contribute to no-reflow. The rate of no-reflow was lower in patients presented with AMI, who had reperfusion in less than 4 hours. In AMI within 4 hours of pain-to-balloon time, the proportion of reversible causes of no-reflow may be higher compared to irreversible causes. The incidence of no-reflow was higher in patients with attenuated plaque ≥5 mm in length as evaluated by intravascular ultrasound (IVUS).Objective:The aim of this study was to evaluate the effects of no-reflow after PCI and the association between attenuation plaque as detected by IVUS and no-reflow in ACS patients within 4 hours of pain-to-balloon time.Methods and Results:We retrospectively evaluated 77 ACS patients within 4 hours of pain-to-balloon time between December 2020 and March 2022. Patients were divided into the reflow group (final TIMI 3) (n = 58) and the no-reflow group (final TIMI < 3) (n = 19). The median peak creatine kinase (CK) level was significantly higher in the no-reflow group compared to the reflow group (3754 IU/L [IQR: 4155] vs. 1712 IU/L [IQR: 2849]). Blood pressure decrease during PCI was significantly more pronounced in the no-reflow group (47.4% vs. 8.6%, p < 0.001). The proportion of low attenuation plaque observed by IVUS with a length of ≥5 mm was significantly higher in the no-reflow group compared to the reflow group (52.6% vs. 25.5%, p = 0.032). The proportion of low attenuation plaque with an angle of ≥180 degrees was significantly higher in the no-reflow group compared to the reflow group (68.4% vs. 41.2%, p=0.043).Conclusion:In ACS patients within 4 hours of pain-to-balloon time, the peak CK and the decrease in blood pressure during PCI were significantly greater and the proportion of low attenuation plaque with a length of ≥5 mm and an angle of ≥180 degrees were significantly higher in the no-reflow group.

Circulation, Volume 150, Issue Suppl_1, Page A4134273-A4134273, November 12, 2024. Background:Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome and its pathophysiology is not fully understood. A monoamine, 5-hydroxytryptamine (5-HT), is involved in diverse biological functions and suggested to play a role in cardiovascular diseases. However, the clinical relevance of 5-HT in HFpEF remains unclear.Aims:This study aimed to elucidate the clinical significance and prognostic value of 5- HT in patients with HFpEF.Methods:We conducted a prospective study involving 240 consecutive hospitalized patients with HFpEF (mean age 72 years, 52% male). We measured circulating blood 5-HT levels using the enzyme-linked immunosorbent assay method. Clinical and outcome data were collected.Results:Correlation analysis revealed that 5-HT levels were negatively correlated with blood B-type natriuretic peptide concentration and tricuspid regurgitation pressure gradient. When patients were stratified into two groups based on the median 5-HT levels (90.5 ng/mL), Kaplan-Meier analysis showed that HFpEF patients with low blood 5-HT levels had lower event-free survival rates from the composite event of cardiac death and worsening heart failure over a median follow-up period of 725 days (Figure). In a multivariable Cox proportional hazard model adjusting for confounding variables, low levels of 5-HT were independently associated with increased risks of the composite of cardiac events (hazard ratio, 3.25; P < 0.01).Conclusion:Low 5-HT levels are associated with adverse outcomes in patients with HFpEF and 5-HT may serve as a useful biomarker for predicting prognosis in such patients.

Circulation, Volume 150, Issue Suppl_1, Page A4139207-A4139207, November 12, 2024. Background:Occurring in 0.6% to 10% of percutaneous coronary interventions (PCI), no-reflow is a complication associated with poor outcomes like myocardial infarction extension and death. The mechanism behind no-reflow is complex and likely multifactorial, and several drugs have been described for its management including intracoronary epinephrine (ICE) at doses ranging from 50 to 400 µg.Hypothesis:We hypothesize that supraselective administration of ICE at very low doses could be effective in the successful management of no-reflow.Methods:This single-center case series from Bucaramanga, Colombia (August 2021-October 2023) reports on 9 patients with/without ST-segment elevation myocardial infarction who underwent PCI and developed no-reflow. As first-line therapy for no-reflow management, supraselective administration of 5 to 50 µg of ICE was performed through an ad hoc fenestrated angioplasty balloon with a two-way drug perfusion technique (proximal to distal, and distal to proximal) at an approximate rate of 2 µg/min. All patients received a 1000 µg intracoronary bolus of Tirofiban during the procedure, and an IV infusion of 0.15 µg/kg/min was continued up to 24 hours postangioplasty.Results:The mean age of patients was 72.7±10.6 years, and 8 out of 9 patients were male. The mean LVEF was 34±11.3% before PCI. Patients received varying doses of ICE (5, 10, 20, 40 and 50 µg), 7 received it as the first-line treatment, while 2 received it as a second-line option after 360 µg of intracoronary adenosine failed to improve blood flow. TIMI 2 flow (4 patients) and TIMI 3 flow (5 patients) were achieved with no consistent association between higher ICE doses and achieving TIMI 3 flow. All 9 patients were discharged alive from the Cath Lab. However, one patient with LVEF 20% died of pulmonary edema 7 hours postangioplasty. The mean heart rate before and after the procedure was 78±20.8 bpm and 84±18.3 bpm respectively. No severe cardiac arrhythmias were observed. Transient inotropic support with a norepinephrine infusion was needed by 2 patients.Conclusion:The supraselective administration of ICE at very low doses (5-50 µg) resolved no-reflow in 100% of patients with acute coronary syndrome. We propose the use of this drug at very low doses as a first-line therapy for the management of coronary no-reflow, as well as the development of future randomized control trials to evaluate its effectiveness, and compare it to current therapies, in a larger population.

Circulation, Volume 150, Issue Suppl_1, Page A4139970-A4139970, November 12, 2024. Introduction:Anticoagulation (AC) is the mainstay of thromboprophylaxis for stroke prevention in atrial fibrillation (AF) and is recommended. Gastrointestinal bleeding (GIB) is a common complication with varied severity and often poses a challenge for cardiologists and gastroenterologists. The decision of whether to continue anticoagulation, when to resume and at what dose is often the challenge. Our study assesses the safety and efficacy of low-dose apixaban compared to a full-dose in patients with AF who had GIB over the course of 5 years.Methods:We queried the US Collaborative Network (which contains 63 healthcare organizations) of TriNetX deidentified research database. Patients with atrial fibrillation who have history of gastrointestinal bleed who received apixaban were identified and divided into two cohorts; patients on low dose of 2.5mg and those on full dose of 5mg. We excluded patients with serum creatinine ≥ 1.5 mg/dL and patients with body weight ≤ 132 lbs.Two well-matched cohorts were created using a 1:1 propensity-score matching (PSM) model using patients’ baseline characteristics and comorbidities. PSM components were age, gender, race, PPI use, anti-platelets, hypertension, coronary artery disease, heart failure, COPD, and CKD. We compared the risk of stroke, GIB, and mortality in 5 years.Results:A total of 19,427 patients with UGIB who have AFIB received oral apixaban were identified. Of those, 19% (n=3,701) were on low dose of 2.5mg and 81% (n=15,726) were on full dose of 5mg of apixaban. After PSM, each cohort included 3,701 patients. There was no statistically significant difference in the risk of stroke in 5 years between the patients on low dose compared to those on full dose (10.9% vs 11.9%, p=0.3). However, patients on low dose had a statistically significant lower risk of GIB compared to those on full dose (30.4% vs 35.3%, p

Circulation, Volume 150, Issue Suppl_1, Page A4144749-A4144749, November 12, 2024. Background:Although high rates of P2Y12 inhibitor pretreatment for non-ST-elevation acute coronary syndrome (NSTE-ACS) have been reported, contemporary practice pattern in the U.S. are not well studied.Objectives:To investigate the temporal trends, variability, and clinical outcomes of P2Y12 inhibitor pretreatment in NSTE-ACS across U.S.Methods:Consecutive patients that underwent early invasive strategy for NSTE-ACS (coronary angiogram ≤ 24 hours of arrival) in National Cardiovascular Data Registry (NCDR) Chest Pain-Myocardial Infarction (MI) registry was analyzed. Initially, a time-trend analysis was conducted on the complete cohort from January 1, 2013, to March 31, 2023. Subsequently, a more recent cohort (January 1, 2019, to March 31, 2023), with a complete set of variables, was used to construct a hierarchical regression model to quantify variability in the use of pretreatment among institutions and hospital regions. For this contemporary cohort, instrumental variable analysis was performed to compare in-hospital outcomes between patients who received pretreatment and those who did not.Results:Use of P2Y12 inhibitor pretreatment has decreased from 24.8% in 2013Q1 to 12.4% in 2023Q3. Among the contemporary cohort of 110,148 patients (2019-23; mean age, 63.9 [SD 12.5] years; 33.0% female), 17,509 (15.9%) received pretreatment. Significant variability in P2Y12 inhibitor pretreatment was observed (range: 0-100%): hierarchical regression model demonstrated that two identical patients would have more than a three-fold difference in the odds of pretreatment by changing institution or hospital region (OR 3.63; 95% CI, 3.51-3.74 and 3.21; 95% CI, 2.90-3.54, respectively). Instrumental variable analysis demonstrated no significant differences in in-hospital all-cause death (1.5% vs 1.7%; p=0.071), recurrent MI (0.56% vs 0.57%; p=0.98), or major bleeding (2.7% vs 2.8%; p=0.98) between the two groups. However, in patients who underwent coronary artery bypass surgery, pretreatment was associated with a longer length of stay (11.2 ± 5.1 days vs 9.8 ± 5.0 days; p < 0.001).Conclusions:Within the nationwide registry in the U.S., we observed a significant variability in the use of P2Y12 inhibitor pretreatment among NSTE-ACS patients in the U.S. Given the lack of clear advantages and the potential for prolonged hospital stays, our findings highlight the importance of efforts to improve standardization.

Circulation, Volume 150, Issue Suppl_1, Page A4134796-A4134796, November 12, 2024. Introduction:Over 6 million patients (pts) present to US emergency departments annually with chest pain (CP), of which the majority are found to have no serious disease. Evaluation of these pts results in substantial costs for unnecessary hospitalization and extensive testing. We evaluated the utility of early discharge of selected low-risk (LR) CP pts from a chest pain unit (CPU) in which no predischarge testing or risk scores were used.Methods:This retrospective study analyzed 1,037 consecutive LR CP pts from a prospectively recorded database. LR was based on normal examination, stable hemodynamics, normal electrocardiograms (ECG), and negative cardiac troponin I, without pre-discharge functional or anatomic cardiac testing or risk scores. We assessed demographics, comorbidities, medications, and major cardiac events at 30 d and 6 mos post-discharge.Results:The study group of 1037 pts comprised 26% of the 4010 pts admitted to the CPU during the study interval from May 2005 to March 2015. Mean patient age was 55 yrs, 56% (n=575) were women, and comorbid conditions were frequent: hypertension (64.1%), dyslipidemia (46.1%), diabetes (25.7%), documented coronary artery disease (19.3%), previous revascularization (20.6%), previous myocardial infarction (10.1%). Length of stay (LOS) in the CPU to discharge was 10.4 hrs. Women received more discharge cardiac medications than men: antiplatelet agents, statins, beta blockers, ACE inhibitors, angiotensin II blockers, calcium channel blockers, and nitrates (p=0.0002 – 0.04).Follow-up (F/U) at 30 d was 91% (n=948) complete and revealed 0.3% (n=3) cardiac deaths, 0.6% (n=6) acute coronary syndromes (ACS), and 6.2% (n= 64) receiving revascularization. F/U at 6 mos was 90% (n=936) complete and total cumulative cardiac deaths were 0.9% (n=9), 0.7% (n=7) ACS and 6.3% (n=65) revascularization.Discussion:Cardiac events at both 30 d and 6 mos were very low and did not differ in men and women (P=0.8). LOS in CPU was minimized and patient safety was maintained. These selected LR pts remained at reduced risk for cardiac events despite a high rate of comorbidities. Early discharge of selected LR CP pts based on history, examination, ECG, and biomarker evaluation was safe and effective.Conclusion:This approach in selected LR pts has the potential to reduce unnecessary diagnostic testing and CPU LOS. This strategy could lead to substantial savings in healthcare costs without compromising patient safety.

Circulation, Volume 150, Issue Suppl_1, Page A4143426-A4143426, November 12, 2024. Background:Massage therapy has been increasingly recognized as a complementary intervention that can help alleviate pain and anxiety in various clinical settings. However, the efficacy of this intervention in patients undergoing cardiac surgeries remains unclear. This systematic review and meta-analysis aims to evaluate the existing evidence of massage therapy for postoperative pain in cardiac surgery patients.Methods:We systematically searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) analyzing the efficacy of massage therapy in patients undergoing cardiac surgeries. We pooled standardized mean differences (SMD) for continuous outcomes with 95% confidence intervals (CI) with a random-effects model. We utilized mean change from baseline values and post intervention values in separated plots to preserve the weighting of this meta-analysis. We performed a trial sequential analysis (TSA) to assess the random risk of postoperative pain with mean change from baseline values. We used R version 4.3.2 and TSA version 0.9.5.10 for statistical analyses.Results:Our meta-analysis included 12 RCTs comprising 1015 patients, of whom 484 (47.7%) were randomized to massage therapy. Compared with control, massage significant reduced postoperative pain based on mean change from baseline values (SMD -0.47; 95% CI: -0.73 to -0.21; p

Circulation, Volume 150, Issue Suppl_1, Page A4146790-A4146790, November 12, 2024. Introduction:Available data suggest there is some regularity in the time of the day when patients experience their first clinical symptoms (pain) of ST Elevation Myocardial Infarction (STEMI). It has been noticed that the largest number of cases of myocardial infarction are observed in the early morning. Some studies, especially in Asian populations, have found a shift into the afternoon hours. Additionally, some publications suggest the existence of secondary peaks of incidence in the evening hours. There also seems to be a relationship between night hours and the occurrence of myocardial infarctions in patients with sleep apnea. Although the risk of myocardial infarction is highest in the morning, there are differences depending on the region and population which might indicate the influence of local and individual factors on the circadian rhythm of the disease.Objective:To analyze circadian variation of STEMI first chest pain onset occurence on one of the largest populations tested so far and to see if there is an association with time delays to Percutaneous Coronary Intervention (PCI).Methods:Data from the Polish National PCI Registry (ORPKI Registry) on patients with confirmed STEMI diagnosis who underwent either coronary angiography and/or PCI from 2014 untill 2022 were analyzed.Results:There were 153 543 individual patients in the analyzed time period with 68% of males. Circadian variation in the probablity of STEMI occurence in both men and women is presented in Figure 1 (p >0.05). Median time from chest pain onset to first medical contact (FMC) was 180 minutes (60-260; 95% CI) at 3 am and 90 minutes (59-196; 95% CI) at 1 pm respectively (p

Circulation, Volume 150, Issue Suppl_1, Page A4140089-A4140089, November 12, 2024. Background:Lipid-lowering therapy for patients with acute myocardial infarction (AMI) is highly recommended, however, a paradox may exist where lower low-density lipoprotein cholesterol (LDL-C) levels at myocardial infarction (MI) are associated with poorer prognoses.Aim:To evaluate the association between baseline LDL-C levels and cardiovascular events after MI.Methods:We studied 1,987 consecutive AMI patients who underwent primary percutaneous coronary intervention and who had available data on preprocedural LDL-C between 1999-2015 at Juntendo University Shizuoka Hospital. Patients were divided into quartiles based on their LDL-C levels. The incidence of major adverse cardiac events (MACE), including all-cause death and recurrent MI up to 5-year, were evaluated.Results:Patients in the lowest LDL-C group were older and had higher prevalence of hypertension, diabetes mellitus and chronic kidney disease. During follow-up, 455 (20.9%) MACE were identified. Cumulative incidence of MACE was significantly higher in the lowest LDL-C group than in other groups (p

Circulation, Volume 150, Issue Suppl_1, Page A4129733-A4129733, November 12, 2024. Background:The impact of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on lipid components is unclear. The objective of this study was to measure the lipid-lowering effect of GLP-1RAs.Methods:A thorough database search was performed to identify placebo-controlled randomized controlled trials (RCTs) on GLP-1RA therapy through January 2023. From these trials, data was extracted and a robust statistical analysis was performed using a random effects model to determine outcomes with weighted mean difference (MD) in milligrams per deciliter (mg/dL) and 95% confidence intervals (CIs). The primary outcome was the mean difference in low-density lipoprotein cholesterol (LDL-C). Secondary outcomes were mean differences in total cholesterol (TC), triglycerides, high-density lipoprotein-C (HLD-C), and very low-density lipoprotein-C (VLDL-C). To account for covariates, subgroup analyses and meta-regression were performed.Results:A total of 33 studies were included in the final meta-analysis carried out between 2008 and 2023, which were conducted in 26 countries. Of the 5,918 participants, the study population comprised 2,603 (44%) males and 3,315 (56%) females, aged between 33.7 and 65.9 years. GLP-1RAs significantly reduced LDL-C compared to placebo (MD -2.93, 95% CI (-5.01, -0.85), P=0.01). Treatment effect was consistent regardless of duration of treatment;12 weeks or less MD: -5.39, 95% CI (-10.36, -0.42), P=0.03 vs >12 weeks MD: -2.39, 95% CI (-4.70, -0.007), P=0.04, P interaction 0.28). In our analysis, GLP-1RA reduced TC by ~7 mg/dl. There was no significant reduction in triglycerides (MD = -7.19, 95% CI (- 15.01, 0.62], P=0.07) and VLDL-C ~4 mg/dl (MD = -3.99, 95%, CI (-8.73, 0.75), P=0.10). Furthermore, GLP-1RA did not increase HDL-C (MD = -0.12, 95% CI (-0.73, 0.49], P=0.69. Regression analysis determined that weight loss did not affect the treatment effect on LDL-C (tau2=28.38, I2=99.83, R2=0.0, p=0.67), and total cholesterol (tau2=93.6, I2=99.86, R2=0.0, p=0.92).Conclusion:Patients on GLP-1RA experienced modest LDL-C and TC lowering compared to placebo. GLP-1RA did not decrease triglycerides and VLDL-C. GLP-1RA did not increase HDL-C.