Risultati per: Infezione da Helicobacter pylori: review

Circulation, Volume 150, Issue Suppl_1, Page A4138850-A4138850, November 12, 2024. Introduction:Mitral regurgitation is the second most common valvular heart disease, it has a high prevelance in older patients, transcatheter mitral valve edge-to-edge repair has been introduced as an alternative treatment to mitral valve surgery especially in the elderly, MitraClip is used as a standard treatment for transcatheter mitral valve edge-to-edge repair (M-TEER). PASCAL has recently been used with minimal evidence comparing both of them.Aim:We aimed to compare the outcomes of both device systems on mitral regurgitation residuals and clinical outcomes.Methods:PubMed, Scopus, WOS, and Cochrane were retrieved from inception until May 2024 for relevant clinical studies that compared PASCAL to MitraClip approaches in M-TEER procedure and reported the primary outcome of interest, which was the grade of MR at follow-up. Other reported outcomes were technical success, Death from any cause, and reintervention, Dichotomous data were analyzed using OR and 95% CI with a fixed-effect model.Results:Seven studies were included with a total of 1834 patients. MR ≤ 2 at discharge was less with MitraClip (RR, 0.67, 95%CI [0.45 to 1]), and MR ≤ 2 at follow-up was less with MitraClip (RR, 0.84, 95% CI [0.64 to 1.1]), MR ≤ 1 at follow up was significantly less with MitraClip (RR 0.69, [0.56 to 0.85]). However, there were no significant differences in technical success, Death from any cause, or reintervention between the two systems used.Conclusion:MitraClip and PASCAL are similar in procedural success, with better outcomes for PASCAL regarding Mitral regurgitation grades after the procedure. The guide to proceed with MitraClip or PASCAL should be guided by mitral valve anatomy, the etiology of MR, and device-specific features. Also, Large-volume RCTs are warranted to validate the current findings.

Circulation, Volume 150, Issue Suppl_1, Page A4144767-A4144767, November 12, 2024. Background:The efficacy of beta-blockers (BB) in patients with heart failure and reduced ejection fraction (EF) is well established. In fact, current guidelines widely recommend BB use after myocardial infarction (MI). However, the effects of long-term BB therapy in patients with acute myocardial infarction (AMI) and preserved EF remains uncertain.Hypothesis:The use of BB after AMI improves long-term outcomes in patients with preserved EF.Aims:To compare the long-term effects of BB with non-BB post AMI in patients with preserved EF.Methods:PubMed, Embase, and Cochrane Library were systematically searched from inception to May 2024 to identify studies comparing BB with no BB use after AMI in patients with preserved EF ( >50%), with a minimum follow-up of 1 year. We pooled hazard ratios (HR) with 95% confidence intervals (CI) to preserve time-to-event data in the pooled analysis. Statistical analyses were performed using R software version 4.3.1.Results:We included two randomized controlled trials and eight cohorts comprising 25,357 patients, of whom 47% received BB and 52% were men. Mean age of patients ranged from 58 to 66.2 years. Follow-up ranged from 1 to 5.2 years. There were no significant differences between groups in all-cause mortality (HR 0.86; 95% CI 0.68-1.08; p=0.20; Figure 1A), myocardial infarction (HR 1.02; 95% CI 0.84-1.24; p=0.86; Figure 1B), or hospitalization for heart failure (HR 1.06; 95% CI 0.78-1.43; p=0.71; Figure 1C). However, when performed a leave-one-out sensitivity analysis in all-cause mortality we saw significant results favoring the use of BB after omitting each study.Conclusion:In this meta-analysis, there were no significant differences in all-cause mortality, myocardial infarction, or hospitalization for heart failure when comparing long-term use of BB with no BB use after AMI in patients with preserved EF. Further trials are needed to clarify the role of BB in this setting.

Circulation, Volume 150, Issue Suppl_1, Page A4144538-A4144538, November 12, 2024. Background:Postural Orthostatic Tachycardia Syndrome (POTS) is a condition characterized by an excessive increase in heart rate upon standing and other autonomic symptoms. Optimal treatments for this disease are still under research. Ivabradine, a selective inhibitor of the If channel, has emerged as a potential treatment for POTS due to its ability to reduce heart rate without affecting blood pressure. In this context, we conducted a systematic review and meta-analysis to assess the impact of ivabradine on Symptoms in POTS patients.Methods:We systematically searched Pubmed, Embase, and Cochrane databases for studies assessing the efficacy and safety of ivabradine in patients with POTS. We calculated event prevalence for binary outcomes and mean value for continuous outcomes, along with 95% confidence intervals (CI). Statistical analysis was performed using R version 4.3.2. A random-effects model was used for all outcomes, and heterogeneity was assessed with Cochrane’s Q and I2 statisticsResults:We included ten studies, comprising 267 patients, of whom 130 (48.68%) were females, with a mean age of 34,68 years, and the heart rate (HR) before ivabradine use ranged between 94.20 and 117.66 bpm. The analysis showed an improvement of symptoms in 90.89% (95% CI: 80.34-98.07;) of patients, and a decrease of 14.46 bpm in HR (95% CI: 7.69-21.24; ), which ranged between 79.82 and 98.25 bpm (95% CI; ). Additionally, we observed side effects events in 9.58% of patients (95% CI: 3.69-17.30;).Conclusion:In patients with POTS, ivabradine appears to be a viable treatment option. Further comparative and more powerful studies are necessary to assess the efficacy and safety of ivabradine in this population.

Circulation, Volume 150, Issue Suppl_1, Page A4134772-A4134772, November 12, 2024. Heart failure with preserved ejection fraction (HFpEF) remains a diagnostic challenge despite a 50% incidence of HF admissions. H2FPEF tool is a validated scoring system that estimates HFpEF probability with a sensitivity of 69% and positive predictive value of 85%. Despite clinical research interest and therapeutic advances in HFpEF, implementation of therapies remain inconsistent. Currently ACC/AHA guidelines classify sodium-glucose cotransporter 2 inhibitors (SGLT2i) use a 2A recommendation with benefits for reducing hospital admissions. We assess the utilization of current guidelines. An observational retrospective analysis was performed of patients >18 years with a left ventricular ejection fraction of >50% seen in cardiology clinic with an ICD.10 code of diastolic heart failure from January 2022 to 2024 at a large tertiary hospital. Electronic records were reviewed for patient demographics, documentation of heart failure diagnosis, medication list and echocardiogram parameters. Primary outcome was HF related hospitalization. The study screened 79 patients, 51% females and 49% males. 20.2% of the patients were on SGLT2i, a quarter of which were female. Of those on SGLT2i, 56% were on diuretics, 81% had H2FpEF score > 5, 56% had diabetes, and 19% had a HF hospitalization. SGLT2i was stopped in 1 patient due to cost. Of the (63) 79.8% of patients not on SGLT2I, 65% were on diuretics, 90% had H2FPEF score > 5, 23% had diabetes and 32% had a HF hospitalization. 43% were males, with an average age of 71 for males and 62 for females. Ten patients had documented reasons for not being on SGLT2i including CKD, dialysis, yeast infection and denied insurance coverage. Unadjusted effect measures for HF hospitalization (HR 0.59, RRR 40.9%, OR 0.496; p 0.134). As guidelines are readily investigated and updated by expert consensus groups, evaluating practice patterns is key. Unlike other cardiac medications, SGLT2is are primarily initiated by cardiologists and recognizing barriers can identify generalizability of current guidelines. Our data looked at both objective and clinical endpoints for HFPEF diagnosis. Interestingly, women were less often started on SGLT2i and coverage was not a frequent cause for not using SGLT2i. Our quality metric analysis shows a potential protective effect of HF readmission with SGLT2i use in a highly symptomatic cohort, and suggests future directives need to focus on broadening educational reach among cardiologists.

Circulation, Volume 150, Issue Suppl_1, Page A4140984-A4140984, November 12, 2024. Introduction:Heart failure (HF) is a prevalent medical condition, affecting approximately 6.7 million Americans. Patients with HF frequently experience comorbidities such as depression and anxiety, which can lead to diminished quality of life. According to the World Health Organization (WHO), palliative care may be beneficial for these patients in addressing their complex physical, mental, and social needs. Therefore, an assessment of palliative care involvement in HF patients is warranted to determine its impact on improving quality of life, alleviating symptoms such as dyspnea, depression, and anxiety.Hypothesis:The aim is to assess the impact of palliative care interventions on the quality of life, dyspnea, anxiety, and depression in patients with HF.Methods:A systematic review and meta-analysis were conducted on clinical trials retrieved from Scopus, Cochrane, PubMed, Embase, and Web of Science databases from their inception until March 2024. Studies reporting on the impact of palliative care interventions on the quality of life of patients with HF were included. The primary outcome was the effect on quality of life, while the effects on dyspnea, depression, and anxiety were secondary outcomes. Data from the studies were pooled using RevMan V5.4, and changes in the mean difference from baseline and confidence intervals (CI) were calculated for each outcome.Results:The meta-analysis included eleven studies, predominantly randomized controlled trials, with a total of 1662 participants, 812 of whom received palliative care interventions. The analysis revealed a significant improvement in the mean change from baseline within the intervention group compared to usual care. Specifically, the quality of life showed a mean difference change from the baseline of 1.35 (95% CI: 0.88 to 1.82), anxiety improved with a mean difference change from baseline of 0.30 (95% CI: 0.03 to 0.58), and dyspnea showed a mean difference change from baseline of 1.0 (95% CI: 0.74 to 1.26). However, there was no significant difference in the mean change from baseline for depression between both groups.Conclusion:Palliative care interventions are associated with significant improvements in quality of life, anxiety, and dyspnea in patients with heart failure compared to usual care. However, there is no significant impact on depression. These findings support the integration of palliative care into the management of heart failure patients to enhance their overall well-being.

Circulation, Volume 150, Issue Suppl_1, Page A4147724-A4147724, November 12, 2024. Background:ST-Elevation Myocardial Infarction (STEMI) has a huge clinical burden globally. Pre-administration of Nicorandil before primary percutaneous coronary intervention for STEMI has demonstrated efficacy in enhancing microvascular recovery and reducing reperfusion injury in RCTs. Consequently, Nicorandil exhibits potential in providing considerable cardioprotective advantage in STEMI patients.Aims:Nicorandil therapy is being extensively investigated as a treatment for reperfusion injury associated with primary percutaneous coronary intervention. This meta-analysis evaluates various studies to determine the cardioprotective effects of nicorandil, with particular emphasis on its influence on infarct size.Methods:MEDLINE (via PubMed), Scopus, Cochrane Library, and Google Scholar were systematically searched for relevant studies. Primary endpoint was infarct size. Left Ventricular End Diastolic volume, Left Ventricular End Systolic Volume, Left Ventricular Ejection Fraction (LVEF), Major Adverse Cardiovascular Events (MACE), and rehospitalizations were analysed as secondary end points. Review Manager 5.4 was used to pool mean differences (MD) and Risk Ratios (RR) along with their 95% Confidence Intervals (CI).Results:3 RCTs including a total of 438 patients were included in our review. Compared with placebo, nicorandil therapy significantly reduced infarct size with a pooled MD of -3.20 (95% CI -5.25 to -1.14). There was also significant reduction in Left Ventricular End Systolic Volume (MD= -5.63; 95% CI -11.22 to -0.05) and a nonsignificant reduction in Left Ventricular End Diastolic Volume (MD= -6.37; 95% CI -12.74 to 0.01). Nicorandil therapy caused a nonsignificant decrease in MACE (RR=0.74; 95% CI 0.37 to 1.46) and readmission rate (RR=0.73; 95% CI 0.30 to 1.77) compared to placebo. It also caused a significant increase in the Left Ventricular Ejection Fraction (LVEF) with a pooled MD of 2.53 (95% CI 0.53-4.54).Conclusion:Pre-treatment with Nicorandil in STEMI patients being treated with primary percutaneous coronary intervention is associated with significant improvement in infarct size and cardiac systolic function.

Circulation, Volume 150, Issue Suppl_1, Page A4140901-A4140901, November 12, 2024. Background:This meta-analysis aims to compare chest compression-only cardiopulmonary resuscitation (CO-CPR) with standard CPR (sCPR), which includes mouth-to-mouth ventilation, as potential strategies for managing out-of-hospital cardiac arrest (OHCA).Methods:We systematically searched various databases and registries such as MEDLINE, Embase, The Cochrane Library, and Clinicaltrials.gov to retrieve relevant studies. We used the revised Cochrane “Risk of bias” tool for randomized trials (RoB 2.0) to assess the risk of bias in included studies. Revman 5.4 was used to pool dichotomous outcomes under a random effects model.Results:A total of 4 RCTs were included in our meta-analysis. Our results indicate that CO-CPR was associated with a significantly increased survival to hospital discharge compared to sCPR (RR 1.22, 95% CI: 1.01 to 1.46) with minimal heterogeneity (I2= 0%). No significant difference was observed between the two groups regarding 1-day survival (RR 1.07, 95% CI: 0.94 to 1.23), survival to hospital admission with a good neurological outcome (CPC 1 or 2) (RR 1.10, 95% CI: 0.80 to 1.51), return of spontaneous circulation (RR 1.05, 95% CI: 0.95 to 1.17), and survival to hospital admission (RR 1.08, 95% CI: 0.93 to 1.25).Conclusion:This meta-analysis found that chest compression-only CPR (CO-CPR) significantly improves survival to hospital discharge compared to standard CPR for managing OHCA while yielding comparable results for other resuscitation outcomes.

Circulation, Volume 150, Issue Suppl_1, Page A4145107-A4145107, November 12, 2024. Background:Kounis syndrome (KS), also known as allergic myocardial infarction, is a rare but potentially life-threatening condition characterized by acute coronary syndrome in the setting of allergic reactions triggered by drugs, foods, vaccines, or environmental exposure. Our study provides an updated comprehensive insight into this patient cohort on a large scale.Methods:We conducted a systemic literature search in PubMed, EMBASE, and Google Scholar between 2018 and 2024, using MeSH terms and keywords for “Kounis syndrome”, “drug”, and allergy to identify the cases of drug-induced KS. Initial search yielded 325 articles. After excluding duplicates, review articles and irrelevant studies, we included only 51 articles reporting drug-induced KS.Results:Our study identified 51 patients of KS with a median age of 56 ± 14 years. Of those, 56.86% were female. The most frequently implicated drugs in KS were antimicrobials (37.25%), followed by iodinated contrast media (19.60%), NSAIDs (15.68%), and antineoplastics (9.80%). Of those, 64.70% of patients were diagnosed with KS-I, 13.72% with KS-II, and 21.56% with KS-III. Chest pain (94.1%), dyspnea (90.1%), and palpitations (60.78%) were predominant initial manifestations, and most cases (78.43%) were presented within 1st hour of drug ingestion. ST-segment changes (100%) were common ECG findings, and 64.70% of patients had elevated cardiac troponin. All patients had reduced left ventricular ejection fraction (LVEF) (

Circulation, Volume 150, Issue Suppl_1, Page A4144136-A4144136, November 12, 2024. Background:Elevated fasting serum triglyceride (TG) levels are linked to an increased risk of cardiovascular disease. Olezarsen is an inhibitor of apolipoprotein C3 (apo-C3) production with a potential to decrease TG levels and thereby, reduce the risk of cardiovascular disease.Research Question:Is olezarsen efficacious and safe in reducing the TG levels?Aim:This meta-analysis aims to evaluate the efficacy and safety of olezarsen in patients with hypertriglyceridemia.Methods:A literature search was carried out on Medline, Embase, Google Scholar, Cochrane CENTRAL, Scopus, and clinicaltrials.gov. Only randomized controlled trials (RCTs), including adult patients with hypertriglyceridemia and treated with olezarsen, were included. The primary outcome assessed was the mean change in the level of TG, whereas the secondary outcomes were changes in the apo-C3, apo-B48, and non-HDL cholesterol levels at the end of the 6-month follow-up period. Various adverse events were also assessed. Review Manager 5.4 was used to calculate standardized mean differences (SMD) with 95% confidence intervals (95% CIs) using a random effects model.Results:Three RCTs involving 334 patients in total, with 248 receiving olezarsen and 86 receiving placebo, were included. The analysis revealed that at the end of the follow up period, there was a significant change in the levels of TG (SMD -52.04, 95%CI: -64.55 to -39.52; p

Circulation, Volume 150, Issue Suppl_1, Page A4142117-A4142117, November 12, 2024. Introduction:The management of patients with Venous thromboembolism (VTE) receiving anticoagulant therapy is complicated by potential interactions with other medications, including antibiotics. Piperacillin-tazobactam (PTZ) has been implicated in unexpected disturbances in the coagulation cascade, which can be critical in patients concurrently using anticoagulants like rivaroxaban. This report explores the complexities of prescribing broad-spectrum antibiotics to patients with pre-existing cardiac conditions and the necessity of careful consideration of drug-drug interactions.Case Report:A 52-year-old white male with a history of deep vein thrombosis on rivaroxaban, presented with severe left leg cellulitis and subsequent gastrointestinal bleeding shortly after the initiation of piperacillin-tazobactam. His presentation was complicated by a rapid deterioration in his condition following a syncopal episode, characterized by hematochezia and hematemesis, necessitating urgent medical interventions including the cessation of all anticoagulation therapy, esophagogastroduodenoscopy and broad-spectrum antibiotics.Discussion:This case highlights the clinical challenges and potential risks of coagulopathies induced by PTZ or the interaction of PTZ with rivaroxaban, stressing the importance of multidisciplinary vigilance. The mechanisms by which PTZ may influence the coagulation pathways in patients already at risk due to their cardiac profiles underscore a significant area of concern for clinicians.

Circulation, Volume 150, Issue Suppl_1, Page A4142988-A4142988, November 12, 2024. Introduction:The latest expert consensus on catheter-based Left Atrial Appendage Occlusion (LAAO) suggests considering either transesophageal echocardiography (TEE) alone or the addition of Cardiac Computed Tomography Angiography (CCTA) for pre-procedural planning. However, evidence comparing the effectiveness of adding CCTA to regular TEE planning on procedural success is limited.Methods:We aimed to perform a systematic review and meta-analysis to determine the impact of adding CCTA to regular TEE for pre-procedural planning in patients undergoing LAAO. We systematically searched Cochrane, Embase, and Medline for observational studies and randomized controlled trials (RCTs) comparing TEE alone to TEE with the addition of CCTA. The primary endpoint was procedural success. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled across studies using a random-effects model.Results:Four studies were included in our meta-analysis, three of which were RCTs and one observational study, comprising a total of 824 patients, of whom 496 (60.2%) underwent additional CCTA. In the pooled analysis, procedural success was higher in the group with added CCTA (RR 1.10; 95% CI 1.01 – 1.19; p=0.022; I2=52%). A subgroup analysis of RCTs alone confirmed these findings, with a slightly higher magnitude of effect in benefit of the addition of CCTA, and with lower heterogeneity (RR 1.15; 95% CI: 1.06 – 1.25; I2 = 0%).Conclusions:In this meta-analysis comparing TEE alone vs TEE with the addition of CCTA for preprocedural planning of LAAO, the addition of CCTA was associated with a higher procedural success rate, and this finding was confirmed in a subgroup analysis of randomized data.

Circulation, Volume 150, Issue Suppl_1, Page A4146421-A4146421, November 12, 2024. Background:The potential benefit of an iatrogenic interatrial shunt in heart failure (HF) is based on observations wherein decompression of the pressure-overloaded left atrium appears beneficial. Consequently, devices designed to mimic this effect have been developed. However, their effectiveness remains controversial.Methods:We searched PubMed, Cochrane, and Embase for randomized controlled trials (RCTs) comparing the use of atrial shunt devices (ASD) versus standard therapy in patients with heart failure with preserved ejection fraction (HFpEF). The outcomes of interest were: (1) quality of life assessed using the Kansas City Cardiomyopathy Questionnaire (KCCQ) and (2) HF events after ASD intervention. Heterogeneity was examined with I2 statistics. Statistical analysis was performed using R Studio 4.3.2.Results:A total of 3 RCTs were included, encompassing 966 patients, of whom 479 (49.5%) were in the ASD group. Most of the participants were female (53%), had a three or higher NYHA class(92%), with a mean age of 72.5 years and a mean follow-up of 1.2 years. In the pooled analysis, there was no difference between groups in improvement of KCCQ (MD 0.65; 95% CI −2.22,3.52; p=0.66;I2=0%; Fig 1) and HF events (RR 1.06; 95% CI 0.81,1.39; p=0.68;I2=0%; Fig 2).Conclusion:In this meta-analysis of patients with HFpEF, ASD therapy was not associated with improvements in quality of life and HF events.

Circulation, Volume 150, Issue Suppl_1, Page A4144137-A4144137, November 12, 2024. Background:The optimal management of angiotensin-converting enzyme (ACE) inhibitors during elective surgeries remains uncertain. While some studies suggest that continuing ACE inhibitors increase the risk of perioperative hypotension, others argue that discontinuation may heighten the risk of significant clinical events. This meta-analysis aims to clarify the clinical outcomes associated with continuation compared to discontinuation of ACE inhibitors in surgical settings.Methods:We conducted a systematic search of MEDLINE, Cochrane, and Embase for clinical trials comparing the effects of continuing versus discontinuing ACE inhibitors during surgery. Outcomes evaluated included death, stroke, myocardial injury (MI), intraoperative hypotension, postoperative hypotension, and acute kidney injury (AKI). Data were synthesized using odds ratios (OR) with 95% confidence intervals (CI). Heterogeneity was assessed with I2 statistics, and a random-effects model was applied. Statistical analyses were performed using R software version 4.3.2.Results:From 865 identified studies, 15 studies involving 11,519 patients met the inclusion criteria. Not all studies had outcomes available for comparison between them. The average age was 65.75 years, with 86.45% having hypertension and 13.13% with heart failure. Continuing ACE inhibitors was associated with a higher risk of intraoperative hypotension (OR 1.33; 95% CI 1.16-1.53). No significant differences were found between groups for mortality (OR 1.06; 95% CI 0.68-1.65), stroke (OR 0.99; 95% CI 0.47-2.09), MI (OR 0.98; 95% CI 0.72-1.31), postoperative hypotension (OR 1.27; 95% CI 0.74-2.17), and AKI (OR 0.88; 95% CI 0.66-1.16).Conclusion:Discontinuation of ACE inhibitors before non-cardiac surgery may lower the risk of intraoperative hypotension without significantly affecting mortality, stroke, MI, postoperative hypotension, or AKI. Further research with greater power and better design is needed to confirm these findings.

Circulation, Volume 150, Issue Suppl_1, Page A4138277-A4138277, November 12, 2024. Background:Bleeding risk is a major concern for patients receiving transcatheter aortic valve implantation (TAVI) due to heparin use. In recent studies, Heparin antagonists, such as protamine, have shown potential in mitigating this complication. We aim to evaluate its potential role in reducing the risk of bleeding in patients post-TAVI.MethodsOn March 18, 2024, related articles were searched in the following databases: PubMed, Embase, Scopus, Web of Science, Cochrane Library, Wiley Library, VHL, Google Scholar, and clinicaltrials.gov. The inclusion criteria consisted of studies that reported the use of protamine in patients who underwent TAVI, with the aim of reducing bleeding risk compared to administering a placebo or no treatment. Our primary outcomes included major bleeding, life-threatening bleeding, the need for blood transfusion, the 30-day mortality rate, and any events of stroke or transient ischemic attack (TIA). The effect size was calculated using the odds ratio with a 95% confidence interval. Meta-analysis was conducted based on random-effect model using Revman.ResultsOut of the 14,705 articles we obtained, only 5 papers were included. One was a randomized controlled trial; the remaining 4 were observational cohorts with control groups. These studies comprised a total of 3,502 patients. Protamine significantly reduced major bleeding (OR 0.44, 95% CI 0.29-0.69, p = 0.0003, I2= 37%), especially with full-dose administration (1 mg/100 U UFH) compared to partial-dose administration (0.5 mg/100 U UFH) (OR 0.38, 95% CI 0.25-0.58, p < 0.00001, I2= 0%). Similarly, protamine significantly reduced life-threatening bleeding (OR 0.37, 95% CI 0.20-0.67, p = 0.001, I2= 4%), particularly with full-dose usage compared to partial-dose (OR 0.37, 95% CI 0.18-0.73, p = 0.004, I2= 0%). However, no significant difference was observed in the need for blood transfusion (OR 0.75, 95% CI 0.46-1.24, p = 0.27, I2= 33%), stroke/TIA risk (OR 0.82, 95% CI 0.41-1.61, p = 0.56, I2= 49%), or 30-day mortality (OR 0.93, 95% CI 0.62-1.39, p = 0.73, I2= 0%).ConclusionsThe use of protamine appears to significantly reduce major and life-threatening bleeding. The need for blood transfusion, risk of stroke or TIA, and 30-day mortality did not show significant differences. These findings suggest that protamine may be an effective intervention for reducing bleeding complications post-TAVI. However, large randomized controlled trials are needed to validate these findings.

Circulation, Volume 150, Issue Suppl_1, Page A4142104-A4142104, November 12, 2024. Objective:This systematic review and meta-analysis aimed to compare the incidence of ischemic stroke and Transient ischemic attack (TIA) post-transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in intermediate or high surgical risk patients with aortic stenosis, as this assessment may influence the choice of intervention.Methods:In accordance with PRISMA guidelines, we conducted a comprehensive search of PubMed, Google Scholar, and Cochrane CENTRAL databases from inception to December 2023 to identify trials and observational studies comparing the incidence of stroke and TIA after 30 days and 1-year post-TAVR vs SAVR from their inception through December 2023. Odds ratios (ORs) with 95% confidence intervals (CIs) for each study, employing a random-effects model for data synthesis irrespective of heterogeneity, were utilized as measures of outcomes. Heterogeneity was assessed using I2 statistics. All statistical analyses were conducted using Review Manager (Rev Man, Version 5.4; The Cochrane Collaboration, Copenhagen, Denmark).Results:After screening of 4549 articles, eight randomized controlled trial studies consisting of 5 randomized controlled trials and three observational studies with a total of 6879 patients were included in this meta-analysis; six studies comparing 30-day stroke incidence, no significant difference was found between TAVR and SAVR (OR 0.83, 95% CI 0.59 to 1.17, p=0.30, I2 3%). Seven studies showed that TAVR patients had a similar 1-year stroke risk to SAVR patients (OR 0.92, 95% CI 0.64 to 1.33, p=0.67, I2 52%). In the TIA case, there was no evidence of a significant difference between TAVR and SAVR in the risk of having a transient ischemic attack within 30 days following surgery (OR 0.93, 95% CI 0.24 to 3.63, p=0.92, I2 52%), although There was a greater 1-year risk of having a transient ischemic attack in the TAVR group compared to the SAVR group, OR 1.15 (95% CI 0.72 to 1.82, p=0.56, I2 0%), however, this was not a statistically significant difference.Conclusion:Our meta-analysis showed no significant differences in either ischemic stroke or TIA occurrences within 30 days and 1-year post TAVR and post SAVR in intermediate or high surgical risk patients.

Circulation, Volume 150, Issue Suppl_1, Page A4146402-A4146402, November 12, 2024. Background:Previous clinical trials demonstrated the efficacy of beta-blockers (BB) after myocardial infarction (MI). However, the effects and safety of BB in patients with chronic obstructive pulmonary disease(COPD) after MI remain a mystery. Therefore, we conducted a systematic review and meta-analysis evaluating beta-blocker use after MI in patients with COPD.Methods:We performed a systematic review and meta-analysis of observational studies that included patients with COPD who received BB after an episode of MI. We searched through Pubmed, Cochrane, and Embase databases. Our primary efficacy outcome was (1) all-cause mortality, and our safety outcome was (2) COPD-related and respiratory adverse events. In our secondary analysis, we evaluated all-cause mortality in patients with a prior history of heart failure (HF). Statistical analysis was done using R Studio 4.3.2.Results:A total of 6 studies were included, encompassing 41840 patients, of whom 16561 (39.5%) were in the beta-blocker group. Most of the participants were male (65%) and the mean follow-up was 5.1 years. In the pooled analysis, all-cause mortality was significantly lower in the BB group (HR 0.81; 95% CI 0.66, 0.98; p = 0.03, Fig 1A). Our secondary analysis in the HF subgroup also showed a significant risk reduction in all-cause mortality(HR 0.80; 95% CI 0.66, 0.97; p = 0.02, Fig 1B.) Regarding COPD-related and respiratory adverse events, the analysis demonstrated a significantly lower incidence in the BB group (HR 0.79; 95% CI 0.74, 0.83; p