Risultati per: Progressi nel trattamento della psoriasi: review

Circulation, Volume 150, Issue Suppl_1, Page A4139378-A4139378, November 12, 2024. Introduction:The potential benefits and risks of paclitaxel-coated balloon (PCB) angioplasty over uncoated balloon (UB) angioplasty in the management of coronary in-stent restenosis (ISR) is not well established.Hypothesis/Aims:This study aims to determine whether PCB angioplasty is superior to UB angioplasty in patients with coronary ISR in terms of target lesion revascularization (TLR), myocardial infarction (MI), and all-cause mortality rates.Methods:PubMed, Embase and Cochrane Central databases were systematically searched for randomized clinical trials (RCT) comparing PCB with UB angioplasty in patients with coronary ISR. Statistical analyses were performed using Review Manager version 5.4.1. Risk Ratios (RR) with 95% confidence intervals (CI) for dichotomous endpoints were computed with the use of a Mantel-Haenszel random effects model.Results:A total of 1,407 patients from 7 randomized clinical trials were included. Follow-up periods in the included studies ranged from 6 months to 1 year. PCB angioplasty significantly reduced TLR (RR 0.28; 95% CI 0.16-0.48; p

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 A4139964-A4139964, November 12, 2024. Background:Transthyretin amyloid cardiomyopathy (ATTR-CM) is estimated to occur in 120,000 US adults and remains underdiagnosed. However, awareness of ATTR-CM has improved following the introduction of new diagnostic tools and disease-modifying treatments. Hence, patients (pts) enrolled in contemporary clinical trials could be at an earlier stage of the disease than pts in past clinical studies.Aim:To assess temporal trends in the baseline risk of pts with ATTR-CM enrolled in clinical trials.Methods:Embase, MEDLINE, CENTRAL, and conference websites were searched on November 23, 2023, for peer-reviewed articles and abstracts. Randomized and single-arm clinical trials examining treatments for ATTR-CM were included, and baseline characteristics and outcomes in pts treated with placebo (PBO) were compared across studies.Results:We reviewed 39 publications derived from 4 randomized and 4 single-arm trials. Studies enrolled pts between 2008 and 2021, although 1 study (INOCARD, 2022) did not report years of enrollment. Several baseline characteristics were comparable across studies, including sex, age, race/ethnicity, genotype, and troponin I level. NYHA class at baseline varied with year of enrollment, with fewer NYHA class III pts in recent trials (Figure). Recent trials also showed a trend toward lower NT-proBNP levels (medians ranging from 1911-3178 pg/mL) and higher eGFR levels (means ranging from 54.7-69.0 mL/min/1.73 m2). In PBO groups, all-cause mortality (ACM) rates at 12 months dropped from 9% in ATTR-ACT (enrolled 2013-2015) to 6.9% in ATTRibute-CM (enrolled 2019-2020) and 5.6% in APOLLO-B (enrolled 2019-2021); ACM rates at 30 months dropped from 42.9% in ATTR-ACT to 25.7% in ATTRibute-CM.Conclusions:This systematic review found that disease-modifying treatments and diagnostic advances have led to earlier diagnosis of pts with ATTR-CM. Recent clinical trials appear to have enrolled pts with a better prognosis. Comparisons of results across these trials are limited and should acknowledge the potential impact of variability in baseline risks among trial populations.

Circulation, Volume 150, Issue Suppl_1, Page A4143120-A4143120, November 12, 2024. Introduction:In patients who have undergone catheter ablation due to atrial fibrillation (AF), recurrence of this condition can occur. The effect of Sacubitril/Valsartan (S/V) on preventing atrial fibrillation recurrence compared to Angiotensin-Converting Enzyme Inhibitor (ACEI) or Angiotensin II Receptor Blocker (ARB) is not established. This meta-analysis aims to establish the best therapeutic choice for preventing AF recurrence after catheter ablation.Method:A systematic search was conducted in PubMed, Embase, and Cochrane databases for randomized clinical trial (RCT) and observational studies comparing the use of S/V with ACEI/ARB in patients who underwent catheter ablation. Results were presented as mean differences (MD) with a 95% confidence interval (CI). Heterogeneity was assessed by I2, and outcomes were expressed as relative risks (RR), using R software version 4.2.3.Results:Three randomized clinical trials and one cohort study, comprising 642 patients with 319 patients in the S/V group and 323 in the control group, were included. Follow-up ranged from 6 to 36 months, with mean ages ranging from 58.9 to 65.8 years. A significant reduction in persistent AF occurrence was demonstrated favoring the S/V group (RR: 0.54; 95% CI: 0.41 to 0.70; P=0.000004; I2: 80%) compared to the ACEI/ARB group. The analysis also showed a significant reduction in Left Atrial Volume Index (LAVI) (MD: -5.33; 95% CI: -8.76 to -1.90; P=0.002; I2: 57%) in the S/V group compared to ACEI/ARB. There was no significant difference in left ventricular ejection fraction (LVEF) with S/V use (MD: 1.23; 95% CI: -0.12 to 2.60; P=0.076; I2: 0%) compared to ACEI/ARB.Conclusion:This meta-analysis demonstrated the efficacy of S/V in reducing the incidence of AF in patients undergoing catheter ablation compared to the use of ACEI/ARB. However, more randomized clinical trials are needed for a comprehensive evaluation of its efficacy in reducing AF recurrence in post-catheter ablation patients in clinical practice.

Circulation, Volume 150, Issue Suppl_1, Page A4137467-A4137467, November 12, 2024. Background:Intravascular ultrasound (IVUS) guidance during percutaneous coronary intervention (PCI) allows better visualization of atherosclerotic plaques than angiography alone. We conducted a systematic review and meta-analysis to comprehensively synthesize the available evidence regarding the efficacy of IVUS-guidance compared to angiography-guided PCI. Moreover, we conducted a sensitivity analysis to determine the applicability of IVUS guidance in complex PCI.Methods:We conducted a comprehensive literature search of major bibliographic databases from inception until May 2024 to identify randomized controlled trials (RCTs) comparing IVUS-guided versus angiography-guided PCI. Risk ratios (RR) with their corresponding 95% confidence intervals (CI) were pooled using the random-effects model, with a p-value

Circulation, Volume 150, Issue Suppl_1, Page A4146232-A4146232, November 12, 2024. Background:Kidney transplant is the most common transplanted organ in the world. However, the efficacy of transplants from deceased donors with acute kidney injury (AKI) before transplantation is a matter of debate. For this reason, we performed a meta-analysis to assess the outcomes of kidney transplants from deceased donors with AKI when compared to non-AKI deceased donors.Methods:We systematically searched MedLine, Embase, and Cochrane databases for studies comparing kidney transplants from deceased donors with AKI compared to those without AKI. The endpoints were Acute Rejection (AR), Delayed Graft Function (DGF), and Graft Failure (GF). We calculated event prevalence with risk ratios for binary 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 statistics.Results:We included 10 retrospective cohort studies, that comprised 68,619 patients, where 33,623 (49%) were females after we disposed of major overlapping populations. We found that the overall risk of AR, DGF, and GF to be respectively (RR 0.93; 95% CI: 0.88 to 0.98; p

Circulation, Volume 150, Issue Suppl_1, Page A4139425-A4139425, November 12, 2024. Introduction:Although prior reports suggest that percutaneous coronary intervention (PCI) of non-infarct-related artery (NIRA) in patients with acute myocardial infarction (AMI) and multivessel disease improves clinical outcomes, the optimal timing for NIRA-PCI remains debated.Research Questions:When is the preferred timing to perform NIRA-PCI after infarct-related-artery (IRA)- PCI?Aims:We aimed to compare the clinical outcomes based on PCI strategies classified by the timing of NIRA-PCI in AMI patients with multivessel disease.Methods:We performed a systematic review and network meta-analysis of randomized controlled trials (RCTs) evaluating clinical outcomes to compare PCI strategies for multivessel disease in AMI patients until September 2023. The primary outcome measure was all-cause death, while the secondary outcomes included myocardial infarction, stroke, coronary revascularization, and bleeding.Results:We included 22 RCTs (N=13,093) comparing the IRA only-PCI and NIRA-PCI strategies. Immediate NIRA-PCI strategy was defined as performing NIRA-PCI after IRA-PCI without delay. Staged NIRA-PCI strategies were categorized into three groups based on the protocol-defined or treated timing for NIRA-PCI from the IRA-PCI: within one week (Staged_Within1W), one week to one month (Staged_1Wto1M), and after one month (Staged_After1M). Compared with IRA-only PCI, Staged_Within1W had significantly lower risks for all-cause death, myocardial infarction, and coronary revascularization. The immediate PCI strategy relative to IRA-only PCI favored for myocardial infarction and coronary revascularization; however, there was no significant difference for all-cause death. Although Staged_1Wto1M or Staged_After1M showed trends similar to Staged_Within1W, all outcome measures had no significant difference. The risk for bleeding or stroke was comparable among the four strategies.Conclusions:This meta-analysis demonstrated a consistent benefit of the NIRA-PCI strategies relative to IRA-only PCI strategy in patients with AMI and multivessel disease. Among the NIRA-PCI strategies, NIRA-PCI within one week appeared the most preferred strategy in patients with AMI and multivessel disease.

Circulation, Volume 150, Issue Suppl_1, Page A4145460-A4145460, November 12, 2024. Takotsubo syndrome (TTS) is a rare cardiovascular condition characterized by reversible ventricular dysfunction and a presentation resembling that of acute myocardial infarction. An increasing number of studies has shown physical stress as a trigger for TTS. Here, we comprehensively reviewed the literature and examined the available evidence for TTS patients triggered by sports. After searching PubMed, Embase, Web of Science and Scopus databases, two investigators independently reviewed 837 studies published through July 24, 2023. Of these studies, 21 met the inclusion criteria (n = 23 patients), including 9 patients with exercise stress test, 14 patients with daily physical activity. In Sports-trigger TTS patients, the most common TTS symptom was dyspnea (69.57%), followed by chest pain (52.17%) and diaphoresis (13.04%). The most common type of TTS was apical, accounting for 69.57% of cases, followed by the midventricular (21.74%) and basal (8.70%) types. The overall mortality rate for Sports-trigger TTS patients was 0.00%. Exercise stress test (39.13%), swimming (21.74%) and diving (21.74%) are the most frequently identified physical activity triggers of TTS. Sports is a potential etiology of TTS patients, rare but it is associated with excellent prognosis. Furthermore, the diagnosis of TTS must be considered in patients with typical symptom after sports. Future prospective studies are needed to establish appropriate guidelines for avoiding TTS during sports and the appropriate exercise prescription for Sports-trigger TTS patients to recovery.

Circulation, Volume 150, Issue Suppl_1, Page A4135791-A4135791, November 12, 2024. Background:While non-vitamin K antagonist oral anticoagulants (NOACs) are more effective than single antiplatelets (mostly low-dose aspirin) at reducing stroke risk in patients with atrial fibrillation (AF), differences in bleeding risk between NOACs and single-dose antiplatelets across various populations remain unclear.Aim:We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing bleeding outcomes of NOACs versus single antiplatelet therapy.Methods:We searched MEDLINE, EMBASE, and CENTRAL to June 2024 for RCTs that compared NOAC (therapeutic doses used for stroke prevention in AF patients) versus single antiplatelet therapy for a treatment duration of ≥3 months. For the meta-analyses, we used fixed-effects models and reported results as summary risk ratios (RRs). We used Risk of Bias 2 and GRADE to assess the quality and certainty of the evidence.Results:Eight RCTs with 26,194 participants were included. Mean follow-up time was 18 (±13) months. NOACs included in the studies were apixaban (4 studies), rivaroxaban (2 studies), and dabigatran (2 studies). All studies used low-dose aspirin as the comparator. When compared to aspirin, NOACs had a higher risk of major bleeding (326/13107 [2.5%] vs. 239/13087 [1.8%] events; RR 1.36 95% CI 1.15-1.60, I2=52%, 8 trials; high certainty) (Figure A), gastrointestinal bleeding (104/8803 [1.2%] vs. 74/8788 [0.8%] events; RR 1.39; 95%CI, 1.04-1.87; I2=0%; 5 trials; high certainty), and clinically relevant non-major bleeding (318/10397 [3.1%] vs. 230/10395 [2.2%] events; RR 1.38; 95%CI, 1.17-1.63; I2=16%; 5 trials; high certainty). There was no difference in the risk of intracranial hemorrhage (88/13107 [0.7%] vs. 84/13087 [0.6%] events; RR 1.04, 95%CI 0.78-1.41; I2=48%; 9 trials; high certainty) (Figure B) nor fatal bleeding (22/12412 [0.2%] vs. 28/12392 [0.2%] events; RR 0.78; 95%CI, 0.45-1.36; I2=8%; 6 trials; high certainty).Conclusion:When compared to aspirin, NOACs are associated with an increased risk of major bleeding and clinically relevant non-major bleeding, but not intracranial hemorrhage. These data are important to inform patients about the risks of antithrombotic treatment.

Circulation, Volume 150, Issue Suppl_1, Page A4119611-A4119611, November 12, 2024. Background:Catheter ablation has emerged as an effective treatment option for atrial fibrillation (AF) in the general population. However, limited data exist on the outcomes of catheter ablation in patients infected with the Human Immunodeficiency Virus (HIV+) with concomitant AF.Objectives:This systematic review and single arm meta-analysis aims to comprehensively evaluate the literature on catheter ablation approach and outcome in HIV+ patients with AF.Methods:A systematic search of PubMed, Embase, and Cochrane Central Register of Controlled Trials was conducted following PRISMA guidelines.Studies meeting the intervention of catheter ablation for AF in HIV+ patients, using radiofrequency, cryoballoon, or pulsed field ablation techniques, were included and data were collected and synthesized using proportion meta-analysis techniques. Statistical analysis was carried out using R software.Results:Three studies met the inclusion criteria, involving 89 HIV+ patients, with an average age of 51.5 years, of whom 83.1% were men, undergoing catheter ablation. Two studies performed received isolation of the pulmonary vein (PV) + posterior wall and superior vena cava. And one study evaluated only the isolation of the pulmonary veins. Of these patients, 43.8% had paroxysmal AF and 56.1% had persistent AF. In two studies reporting freedom from atrial arrhythmias, all patients (62) experienced recurrence of atrial arrhythmias within 5 years of follow-up. Freedom from repeat ablation was 6.26% (Figure 1A). The rate of Pulmonary Vein Trigger was 31.28% (Figure 1B), while the rate of Non-Pulmonary Vein Trigger (non-PV) was 76.64% (Figure 1C).Conclusion:In this systematic review and meta-analysis assessing outcomes of ablation in HIV patients with AF, we observed a similar prevalence of paroxysmal and persistent AF. Furthermore, contrary to the non-HIV+ patients, a high incidence of non-pulmonary vein triggers of AF was noted in this population.

Circulation, Volume 150, Issue Suppl_1, Page A4136009-A4136009, November 12, 2024. Introduction:Since individual adherence/persistence studies for heart failure (HF) guideline-directed medical therapy (GDMT) have mainly focused on single classes or had limited sample sizes, providing inconclusive estimates, a comprehensive analysis is needed to understand the magnitude of the problem.Hypothesis:Adherence and persistence to HF GDMT are suboptimal and are associated with increased risks of HF admission and mortality.Aims:To generate estimates of real-world HF medication adherence and persistence and associated clinical outcomes.Methods:We conducted a systematic review and meta-analysis, searching PubMed, EMBASE, and CINAHL for observational studies on adherence and persistence in HF GDMT from inception to 9/25/23. We evaluated bias using the Newcastle-Ottawa Scale. Primary outcomes were adherence and persistence rates using a restricted maximum-likelihood model. Adherence was summarized as the mean proportion of days covered (PDC) and medication possession ratio (MPR), proportion of patients with good adherence (PDC/MPR≥80%), and persistence. Secondary outcomes were all-cause mortality and HF readmission with summary hazard ratios (HRs) and 95% confidence intervals (CI) estimated. Heterogeneity and publication bias were assessed using Cochran’s Q, I squared statistics, funnel plots, and Egger’s tests, while subgroup analyses explored variations across studies.Results:The 48 studies included comprised 1,614,985 patients (mean age 71; 57% men). The overall mean PDC/MPR was 76%, with good adherence of 54%, and persistence rates of 60%. Renin-angiotensin-aldosterone system inhibitors had the highest mean PDC/MPR of 78%, good adherence of 56%, and persistence of 64%, while mineralocorticoid receptor antagonists (MRAs) had the lowest at 71%, 47%, and 49% respectively. Nonadherence/nonpersistence to GDMT was associated with a higher rate of mortality (HR 1.27 [95% CI 1.19–1.35]) and HF admission (HR 1.25 [95% CI 1.14-1.37]).Conclusions:Suboptimal adherence/persistence to HF GDMT is common, with only half of patients showing good adherence. Given the association with worse clinical outcomes, clinicians should prioritize identifying barriers to and addressing nonadherence/nonpersistence to HF GDMT, particularly with MRAs.

Circulation, Volume 150, Issue Suppl_1, Page A4139264-A4139264, November 12, 2024. Introduction:Pulmonary vein isolation (PVI) is a catheter ablation (CA) technique employed as a treatment strategy for atrial fibrillation in young patients or those who do not respond to medical therapy. Techniques for PVI include radiofrequency (RFA) ablation and balloon cryoablation. The left atrial posterior wall has been recognized as a significant anatomical area involved in the onset and persistence of atrial fibrillation (AF). However, the impact of additional posterior wall isolation (PWI) during PVI remains uncertain.Research Question:What are the outcomes of pulmonary vein isolation compared to pulmonary vein isolation with adjunctive posterior wall isolation in patients with paroxysmal atrial fibrillation?Goals:To determine the efficacy of adjunctive posterior wall isolation in treating persistent AF.Methods:A systematic literature search was conducted on various databases (Pubmed/Medline, EMBASE, Google Scholar, Scopus) from inception until March 2024, to include studies comparing outcomes of patients undergoing management of paroxysmal AF with either PVI + concurrent PWI versus only PVI. Observational studies and Randomized Controlled Trials were included. Review Manager (v 5.3) was used for pooled analysis of included studies employing risk ratio (RR) as the effect measure (4).Results:We conducted a random-effects meta-analysis, pooling data from 5 studies with a total of 2,441 patients. Our analysis revealed a significant improvement in AF recurrence for the cryoablation technique with PVI+PWI (RR=0.56, 95% CI: 0.41, 0.76, I2=0%, p=0.0002) but no significant result was found for PVI+PWI in RFA (RR=1.37, 95% CI: 0.87, 2.18, I2=0%, p=0.18) for AF. For the recurrence of all arrhythmias, the risk ratios for cryoablation and RFA are 0.60 (95% CI: 0.46, 0.78, I2=0%, p=0.0001) and 1.17 (95% CI: 0.83, 1.65, I2=0%, p=0.37) respectively, significant in the case of cryoablation and non-significant for RFA.Conclusion:Concurrent PWI with PVI with the cryoablation technique in patients for the management of paroxysmal AF reduces the risk of recurrent AF. Due to the limited number of studies included, it is possible that the results were underpowered. Further prospective studies in the future are warranted.

Circulation, Volume 150, Issue Suppl_1, Page A4125679-A4125679, November 12, 2024. Introduction:Gender minority (GM; e.g., transgender, non-binary) adults have a higher prevalence of cardiovascular disease (CVD) than their cisgender (i.e., non-transgender) counterparts. Physical activity (PA) is associated with a lower risk of CVD and all-cause mortality. Compared to cisgender adults, GM adults face unique challenges (e.g., discrimination, lack of safe spaces) to meeting aerobic and muscle-strengthening PA recommendations, which may negatively impact their overall health and well-being. There is also limited evidence on factors associated with lower PA among GM adults.Goal:To understand differences in the prevalence of PA between GM and cisgender adults and to identify factors associated with PA among GM adults.Methods:Following the PRISMA guidelines, we performed a comprehensive search using five databases (PubMed, Embase, Web of Since, CINAHL, and Scopus). We included peer-reviewed, English-language, quantitative empirical studies focused on PA among GM adults published between 2004 and 2024. We excluded qualitative studies, reviews, editorials, conference abstracts, and grey literature. We performed quality appraisal using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies.Results:A total of 5,163 articles were retrieved and 24 met inclusion criteria. The included studies had a low to moderate risk of bias. Methodological weaknesses of the included studies were an overreliance on self-reported PA with no objective assessment using accelerometry, use of non-validated PA measures, and limited assessment of muscle-strengthening PA. Most studies (n = 15) reported lower aerobic and muscle-strengthening PA among GM adults compared to their cisgender counterparts. Two studies found that GM adults with higher perceived psychological stress reported lower PA. One study found that GM adults who were on gender-affirming hormone therapy reported higher PA than GM adults who were not.Conclusions:Findings highlight that GM adults report lower aerobic and muscle-strengthening PA than cisgender adults. There is a need for more comprehensive research to understand these disparities and their impact on GM adults’ cardiovascular health. This systematic review can inform future research and the development of tailored interventions to increase PA among GM adults.

Circulation, Volume 150, Issue Suppl_1, Page A4145775-A4145775, November 12, 2024. Background:Cyclophosphamide is an alkylating agent of the nitrogen mustard class that has become standard of care for graft-versus-host disease prophylaxis after hematopoietic stem cell transplantation. Although its cardiac toxicity in conditioning regimens is well-documented, data on cardiac events after administration of post-transplant cyclophosphamide (PT-Cy) administration remains limited.Research Question:Is PT-Cy associated with a higher incidence of cardiac adverse events compared with no PT-Cy?Aims:We aimed to perform a systematic review and meta-analysis of cardiac events from studies comparing PT-Cy versus no PT-Cy in patients with hematological disorders who received hematopoietic stem cell transplantation.Methods:We searched PubMed, Embase, and Cochrane Library for studies comparing PT-Cy versus no PT-Cy in patients with hematological conditions who received hematopoietic stem cell transplantation. We pooled risk ratios (RR) with 95% confidence intervals (CI). Statistical analyses were performed using Review Manager 5.4.1, under a random-effects model. Heterogeneity was assessed using I2 statistics.Results:We included four studies, all of which were retrospective, with 1,546 patients, of whom 826 (53%) received PT-Cy. Age ranged from 18 to 77 years, and 840 (54%) were male. A total of 1549 allogeneic transplants were performed, primarily for malignant hematological conditions. The conditioning regimens used were myeloablative (52%), reduced intensity (33%), non-myeloablative (8%), and sequential (7%). The most common cardiac events in patients receiving PT-Cy were heart failure (28%) and cardiomyopathy (27%), followed by arrhythmias (25%), pericarditis/pericardial effusion (14%) and acute coronary syndrome (5%). The incidence of adverse cardiac events was significantly higher in patients who received PT-Cy compared with those who did not receive PT-Cy (RR 2.05; 95% CI 1.36, 3.10; p

Circulation, Volume 150, Issue Suppl_1, Page ASu504-ASu504, November 12, 2024. Background:Rapid defibrillation by the public with automated external defibrillators (AEDs) is critical to improving out-of-hospital cardiac arrest (OHCA) survival. Concerns about theft, vandalism, and misuse of AEDs have led to the implementation of security measures, including the use of locked cabinets to house these devices in public areas.Aim:This scoping review aims to systematically explore the existing literature on the impact of locked cabinets for AEDs during emergencies.Methods:A search of Medline, Embase, Cochrane, CINAHL and Google Scholar (20 pages) was performed on May 25th 2024. Studies of any design (e.g., experimental, observational, qualitative) that evaluated the impact of locked cabinets on AED accessibility and effectiveness during emergencies. Data were charting was iterative, and after reading included studies the studies were grouped by the outcomes studied.Results:We screened 2,096 titles and found 10 relevant studies: 8 observational studies and 2 OHCA simulation studies. Four papers were only published as conference abstract and no studies reported on patient outcomes. Data were reported on varying numbers of AEDS (ranging from 39 to 31,938) which were located inside buildings and public spaces. Overall theft and vandalism rates were very low, with the majority of studies reporting rates of

Circulation, Volume 150, Issue Suppl_1, Page A4114970-A4114970, November 12, 2024. Background:Pulsed field ablation (PFA) and high-power short-duration radiofrequency ablation (HPSD) are emerging techniques for treating atrial fibrillation (AF), offering promising results compared to cryoballoon ablation (CBA). This network meta-analysis aims to evaluates the efficacy and safety of PFA, HPSD, and CBA.Method:PubMed, Embase, Cochrane Central Register of Controlled Trials, and EBSCO Information Services were systematically searched for relevant studies until April 2024. The primary outcome is freedom from atrial arrhythmia. A random-effects model was used for data synthesis, and P-scores were employed for outcome ranking. Point estimation (odd ratios) was calculated for comparisons.Results:Fifteen studies were included in our network meta-analysis, involving 5,093 atrial fibrillation patients: 812 (16%), 2,659 (52%), and 1,622 (32%) patients underwent PFA, CBA, and HPSD, respectively. PFA demonstrated the highest efficacy (P-scores 99.3%). Point estimation between PFA and HPSD, and PFA and CBA, were 1.394 (95% CI: 1.047-1.858) and 1.479 (95% CI: 1.134–1.929), respectively. PFA had higher complications compared to HPSD (OR=4.44, 95% CI: 1.405-14.031) and CBA (OR=2.581, 95% CI: 0.992–6.720). HPSD had the shortest fluoroscopic time (P-scores 100%), while CBA had the longest (P-scores 0%). PFA had the shortest procedural time compared to CBA and HPSD with P-scores of 100% 50% and 0%, respectively.Conclusion:PFA showed higher efficacy but higher complication risk than HPSD and CBA. HPSD and CBA demonstrated similar efficacy and safety.