Circulation, Volume 150, Issue Suppl_1, Page A4141761-A4141761, November 12, 2024. Background:Rotational atherectomy has been performed using both radial and femoral access over the years, but there is a lack of consensus on the safety and efficacy of these access sites.Aim:To assess the safety and efficacy of radial access and femoral access.Methods:MEDLINE, Scopus, and Cochrane Library were searched until May 2024 for studies comparing radial approach with femoral approach in patients undergoing rotational atherectomy. The primary outcome was major vascular site bleeding. Secondary outcomes included short-term mortality, long-term mortality, myocardial infarction, major adverse cardiovascular events (MACE), acute stent thrombosis, procedural success, procedural time, hospital stay and radiation exposure. Effect estimates were synthesized using a random-effects model and expressed as risk ratios (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, with corresponding 95% confidence intervals (CIs).Results:13 studies including 13,581 patients with mean age of 60.76 years in the radial group and 66.86 years in the femoral group, who had undergone rotational atherectomy, were included in the analysis. For the outcome of major vascular site bleeding, there was significantly lower risk (RR: 0.25; 95% CI [0.15, 0.43]; p
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Abstract 4146232: Kidney Transplant Outcomes From Deceased Donors Who suffered Acute Kidney Injury: Systematic Review and Meta-Analysis
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
Abstract 4138603: Adult-onset Kawasaki Disease: An Updated Review of the English-Language Literature from 1980 Through 2023
Circulation, Volume 150, Issue Suppl_1, Page A4138603-A4138603, November 12, 2024. Introduction:Kawasaki disease (KD) is a pan-vasculitis that primarily affects children and rarely adults. Available data on adult-onset KD are based on case reports and case series, both of which are limited by small sizes. We aimed to characterize the epidemiology, presentation, hospital course, and outcomes of adult-onset KD published in the English literature from 1980 through 2023.Methods:We retrospectively reviewed and included published articles with a diagnosis of KD in patients age ≥18 years. We searched PubMed and Google scholar for case reports/series published in English using the keywords “adult”, “Kawasaki disease”, and “mucocutaneous lymph node syndrome”. We extracted data from individual articles onto an Excel spreadsheet for analysis. Outcomes of interest were the demographic characteristics of patients, clinical presentation and hospital course, management, and complications. Descriptive statistics were used to analyze the data.Results:A total of 137 patients from 29 countries were included in this study. The majority were male (90/137, 64.9%; M:F ratio 1.8) and the median age was 25 years (range, 18-68). The median time to clinical presentation was 5 days (range, 4-60). The main signs and symptoms were fever (95.7%), skin rash (92.9%), conjunctivitis (89.3%), extremity changes (84.3%), oral changes (85.7%), and cervical lymphadenopathy (73.7%). The majority of the patients had no co-morbidities (125/137, 91.2%). EKG changes were not reported in 48 patients (35%). In the remaining 89, 26 (29.2%) had normal EKG or sinus tachycardia, 9 (10.1%) had ST segment elevation, and 9 (10.1%) had arrythmias or abnormal EKGs. Pharmacotherapy included IVIG (80/137, 58.4%), Aspirin (105/137, 76.6%), steroids (31/137, 22.6%) and antibiotics (68/137, 49.6%). For complications, 18.2% (25/137) had aneurysms, 8% (11/137) had myocardial infarction, 10.9% (15/137) had myocarditis, 10% had pericarditis/pericardial effusion, and 10.9% (15/137) had KD shock syndrome. The median length of stay was 14 days (range, 1-60 days). Three patients (2%) died from KD.Conclusion:Adult-onset KD is rare and is associated with significant cardiovascular complications. Clinicians should have high index of suspicion for prompt diagnoses and initiate appropriate treatment to improve outcomes.
Abstract 4138074: Sex differences in safety and efficacy of dual antiplatelet therapy strategies for patients with acute coronary syndromes: A systematic review and meta-analysis
Circulation, Volume 150, Issue Suppl_1, Page A4138074-A4138074, November 12, 2024. Background:Various durations and de-escalation strategies of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention for patients presenting with acute coronary syndromes (ACS) have been reported in randomized controlled trials (RCTs). However, it remains uncertain whether the effect of these DAPT strategies is influenced by sex.Methods:PubMed and EMBASE were searched in May 2024. We included RCTs which investigated DAPT strategies for ACS patients comparing any de-escalation strategies such as short-term DAPT (≤6 months) followed by P2Y12inhibitor or aspirin monotherapy, unguided de-escalation from potent P2Y12inhibitors to low-dose potent P2Y12inhibitors or clopidogrel at one month, and guided de-escalation with platelet function tests, compared with standard duration DAPT (6-12 months). We conducted a systematic review and meta-analysis. The efficacy and safety of each DAPT strategy was compared between sexes, and relative hazard ratios (RHR) were calculated. The primary outcome was net adverse clinical events (NACE), defined as a composite of cardiovascular death, myocardial infarction, stroke, and major bleeding (BARC 3 or 5).Results:Eleven RCTs that enrolled 27,033 patients with ACS were included. De-escalation of antiplatelet therapy had a lower risk of NACE than standard duration DAPT for both female (HR, 0.73; 95% CI, 0.55-0.96;I2=32%) and male (HR, 0.85; 95% CI, 0.74-0.97;I2=23%). There were no significant differences in NACE between female and male patients randomized to de-escalation vs. standard duration DAPT (RHR, 0.84; 95% CI, 0.65-1.09 ;I2=0%) (Figure). Similarly, no significant differences were observed between female and male patients with respect to major adverse cardiovascular events (RHR, 0.75; 95% CI, 0.52-1.08;I2=0%) or major bleeding (RHR, 1.37; 95% CI, 0.85-2.21 ;I2=0%).Conclusion:In patients with ACS, de-escalation of antiplatelet therapy is safe and effective irrespective of sex.
Abstract 4145254: Effects Of Semaglutide On Safety Outcomes In Patients With Type 2 Diabetes Mellitus And High Cardiovascular Risk: A Meta-Analysis Of Randomized Controlled Trials And Systematic Review
Circulation, Volume 150, Issue Suppl_1, Page A4145254-A4145254, November 12, 2024. Background:The efficacy of semaglutide, a glucagon-like peptide-1 receptor agonist, has been studied in patients with type 2 diabetes mellitus (T2DM) who also have advanced chronic kidney disease (CKD) and/or established cardiovascular disease. These conditions pose a high cardiovascular risk. However, the impact of semaglutide on safety outcomes and the incidence of adverse effects in this population remains unclear.Hypothesis:The use of semaglutide is associated with a higher incidence of gastrointestinal adverse events and specific safety concerns such as severe hypoglycemia and retinopathy.Aims:This study aimed to evaluate the impact of semaglutide on safety outcomes in high-risk cardiovascular patients with T2DM.Methods:PubMed, Embase, and Cochrane Central databases were systematically searched in May 2024 for randomized controlled trials (RCTs) that compared semaglutide (oral and subcutaneous) to placebo in adult patients with T2DM with CKD and/or established cardiovascular disease and reported the safety outcomes of (1) gastrointestinal disorder; (2) acute pancreatitis; (2) severe hypoglycemia; (3) retinopathy; (4) acute kidney failure and (5) malignant neoplasm. A systematic review and meta-analysis of the findings were performed using RStudio version 2024.04.0. Heterogeneity was examined with the Cochran Q test and I2 statistics.Results:We included 3 RCTs in the final analysis, with a total of 10.013 participants, of whom 5.006 (49.99%) were on semaglutide. Semaglutide was associated with a significant increase in the incidence of gastrointestinal disorders compared with placebo (OR 2.00; 95% CI 1.07-3.77; p= 0.031; figure 1A). Severe hypoglycemia (OR 1.10; 95% CI 0.92-1.31; p=0.31; figure 1B), acute kidney failure (OR 0.93; 95% CI 0.78-1.10; p= 0.402), acute pancreatitis (OR 0.92; 95% CI 0.49-1.71; p= 0.792), retinopathy (OR 1.17; 95% CI 0.91, 1.50; p=0.225) and malignant neoplasm (OR 1.02; 95% CI 0.85-1.24; p=0.809) were not significantly different between groups.Conclusion:In high cardiovascular risk T2DM patients, semaglutide was associated with a higher incidence of gastrointestinal disorders as compared with placebo.
Abstract 4140260: Efficacy and Safety of Radiofrequency-Based Renal Denervation on Resistant Hypertensive Patients: A Systematic Review and Meta-Analysis
Circulation, Volume 150, Issue Suppl_1, Page A4140260-A4140260, November 12, 2024. Introduction:New therapies for resistant hypertension (RH), including renal denervation (RDN), have been studied.Aim:Access the safety and effectiveness of radiofrequency-based RDN vs pharmacological treatment for RH.Methods:A thorough literature search was conducted across PubMed, EMBASE, and the Cochrane databases, focusing on studies that compared the effects of radiofrequency-based RDN versus pharmacological treatment for RH. Treatment effects for binary and continuous endpoints were pooled and used, respectively, odds-ratio (OR) and mean differences (MD) with 95% confidence intervals (CI) to analyze continuous outcomes.Results:All the 10 included studies were randomized controlled trials, they involved 1.182 patients, and 682 received radiofrequency-based RDN. The follow-up period ranged from 6 to 84 months. Analysis revealed that the RDN group had a significant reduction in office systolic blood pressure (BP) (MD: -9.5 mmHg; 95% CI: -16.81 to -2.29; P=0.01), office diastolic BP (MD: -5.1 mmHg; 95% CI: -8.42 to -2.80; P
Abstract 4140224: Conservative management of patent ductus arteriosus in preterm infants: a systematic review and meta-analysis of randomized controlled trials
Circulation, Volume 150, Issue Suppl_1, Page A4140224-A4140224, November 12, 2024. Background:In recent years, there has been a rise in the adoption of conservative approaches to managing patent ductus arteriosus (PDA) in preterm infants. Systematic appraisal of the clinical evidence supporting this approach is essential for guiding recommendations in clinical guidelines.Methods:A comprehensive search of MEDLINE (PubMed), Embase, the Cochrane Library, and ClinicalTrials.gov, spanning from inception to April 2024, was conducted to identify all relevant randomized controlled trials (RCTs) that evaluated conservative management of patent ductus arteriosus (PDA) in preterm infants. Conservative management was defined as approximately ≤25% open-label pharmacological treatment with ibuprofen, indomethacin, or paracetamol and/or ligation/endovascular closure. Our primary outcomes were the risk of all-cause mortality and bronchopulmonary dysplasia. We used RevMan 5.4 to pool risk ratios (RRs) under a random-effects model, ensuring a rigorous and reliable analysis.Results:Our review included 6 RCTs. There was no difference in the risk of mortality (RR 0.83; 95% CI: 0.64-1.08, I2= 0%) and BPD (RR 0.89; 95% CI: 0.76-1.03, I2= 22%) between the conservative management and active treatment groups. The rates of necrotizing enterocolitis, intraventricular hemorrhage, retinopathy of prematurity, sepsis, pulmonary hemorrhage, and the need for surgical ligation or transcatheter occlusion were similar between the two groups.Conclusions:The meta-analysis showed no difference in the risk of all-cause mortality, BPD, or other clinical outcomes between a strategy of conservative management compared to active treatment. These findings support a conservative approach for the management of PDA in preterm infants. Future studies should focus on cost-effectiveness analyses between the two approaches and investigate important subgroups, such as extremely preterm births.
Abstract 4144767: Long-term effect of beta-blockers after acute myocardial infarction in patients with preserved ejection fraction: A systematic review and meta-analysis
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.
Abstract 4145774: Clinical Outcomes Following Transcatheter Edge-to-Edge Mitral Valve Repair in Cancer Survivors: A Systematic Review and Meta-Analysis
Circulation, Volume 150, Issue Suppl_1, Page A4145774-A4145774, November 12, 2024. Introduction:Little is known about the outcomes of cancer survivors versus patients without a history of cancer undergoing Transcatheter Edge-to-Edge Mitral Valve Repair (TEER) for mitral regurgitation (MR). Moreover, recent publications retrieved conflicting results on the safety and efficacy of TEER in cancer survivors.Hypothesis:Performing TEER in cancer survivors produces similar outcomes when compared to patients with no history of cancer.Aims:Conduct a systematic review and meta-analysis to evaluate clinical outcomes after TEER for MR in patients with versus without a history of cancer.Methods:From inception to December 2023, we systematically searched PubMed, Web of Science, and Embase for studies comparing the safety and efficacy of TEER for MR in cancer survivors versus in patients without a history of cancer. Outcomes of interest were 30-day and 1-year all-cause mortality, incidence of post-procedural MR grade ≥ 3, post-procedural stroke, and 30-day readmissions. Statistical analyses were performed using R software version 4.3.2. We pooled odds ratios (OR) with 95% confidence intervals (CI) for binary endpoints.Results:We included six observational studies comprising 25,334 patients, of whom 6.1% were cancer survivors. Cancer survivors and controls had comparable rates of 30-day all-cause mortality (OR 1.15; 95% CI 0.55 to 2.39; p=0.71), 1-year all-cause mortality (OR 1.61; 95% CI 0.93 to 2.79; p=0.09), post-procedure severe MR (OR 1.49; 95% CI 0.67 to 3.30; p=0.33), post-procedural stroke (OR 1.25; 95% CI 0.47 to 3.27; p=0.66), and 30-day readmission (OR 1.16; 95% CI 0.92 to 1.46; p=0.19).Conclusion:This meta-analysis suggests that cancer survivors with symptomatic MR have similar outcomes after TEER as compared with patients who do not have a history of cancer. Future multicenter studies are warranted to confirm and expand these findings in larger populations and with multivariable-adjusted analysis.
Abstract 4144136: Assessing the Efficacy and Safety of Olezarsen in Lowering Triglyceride Levels: A Systematic Review and Meta-Analysis
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
Abstract 4141750: Catheter Ablation for AF Management in Heart Failure with Preserved Ejection Fraction: A Systematic Review and Meta-Analysis
Circulation, Volume 150, Issue Suppl_1, Page A4141750-A4141750, November 12, 2024. Background:The latest guidelines advocate for catheter ablation (CA) over standard medical therapy (SMT) for managing atrial fibrillation (AF) in patients with heart failure with reduced ejection fraction (HFrEF). However, significant knowledge gaps exist regarding the effectiveness of CA vs. SMT in patients with heart failure with preserved ejection fraction (HFpEF).Methods:PubMed, Scopus, and Embase until February 2024 were systematically searched. Given the limited number of randomized studies, propensity score-matched observational studies comparing CA with SMT in AF patients with HFpEF were also included. The primary outcome was a composite endpoint of all-cause mortality and HF hospitalization.Results:Eight studies that enrolled 17,717 SMT and 2537 CA patients were included. CA was associated with a significantly lower risk of the composite endpoint of all-cause mortality and HF hospitalization (HR 0.69, 95% CI: 0.40-0.98). The risk of HF hospitalization (HR 0.48, 95% CI: 0.17-0.80), cardiovascular mortality (HR 0.27, 95% CI: -0.06-0.61), and AF recurrence (HR 0.53, 95% CI: 0.37-0.70) were also lower in the CA group.Conclusion:CA demonstrated significant cardiovascular morbidity and mortality benefits when compared to SMT in the HFpEF population.
Abstract 4142086: Efficacy And Safety Of Inhaled Nitric Oxide In Pediatric Cardiac Surgery: A Systematic Review And Meta-Analysis
Circulation, Volume 150, Issue Suppl_1, Page A4142086-A4142086, November 12, 2024. Background:Congenital heart diseases affect one in every 100 live births. Surgical intervention is necessary for almost half of these cases, with a significant proportion requiring surgery within the first year after birth. This meta-analysis aims to evaluate the efficacy and safety of inhaled nitric oxide (iNO), selective pulmonary vasodilator, particularly its impact on perioperative clinical outcomes such as low cardiac output syndrome (LCOS), duration of mechanical ventilation, blood and fresh frozen plasma (FFP) transfusion, ICU stay, and hospital stay.Methods:We conducted a comprehensive search of PubMed, Scopus, WOS, and Cochrane databases for relevant studies from inception to April 1, 2024. We included randomized controlled trials (RCTs) comparing iNO with placebo or standard care in pediatric patients undergoing cardiopulmonary bypass. Data extraction and quality assessment were performed according to PRISMA guidelines and Cochrane’s risk of bias tool. Mean differences (MD) and their 95% confidence intervals (CI) were calculated using OpenMeta [Analyst].Results:We included six RCTs in our meta-analysis. Our analysis showed that iNO significantly reduced the duration of mechanical ventilation (MD = -5.733, 95% CI [-10.494; -0.972]). However, no significant differences were observed between the iNO group and the control group for hospital stay, ICU stay, or incidence of LCOS. Safety outcomes showed no significant differences in blood or platelet transfusion rates, though iNO was associated with statistically significant lower FFP transfusion (MD = -5.199, 95% CI [-8.032; -2.366]).Conclusion:our review and meta-analysis highlights the potential benefits of iNO in reducing ventilation time and FFP transfusion in pediatric patients undergoing cardiac surger, while also emphasizing the need for further research to conclusively determine its impact on other clinical outcomes and safety parameters.
Abstract 4144815: Natriuretic peptide-guided therapy in acute decompensated heart failure: An updated systematic review and meta-analysis
Circulation, Volume 150, Issue Suppl_1, Page A4144815-A4144815, November 12, 2024. Background:Natriuretic peptides (NP) are frequently employed in diagnosing heart failure (HF); however, their effectiveness in guiding HF treatment lacks sufficient evidence. To address this gap, we conducted an updated meta-analysis assessing the efficacy of NP-guided therapy versus usual care in decompensated HF.Methods:PubMed, Embase and Cochrane database were searched for randomized controlled trials (RCTs) that compared NP-guided treatment to usual care for patients with acute decompensated heart failure. The reported outcomes were (1) all-cause mortality; (2) cardiovascular death; and a (3) composite of all-cause mortality and HF hospitalizations. Heterogeneity was examined with I2statistics. A random-effects model was used for outcomes with high heterogeneity. Statistical analysis was done using R Studio 4.3.2.Results:We included 10 RCTs with 4122 patients, of whom 2072 (50.3%) underwent NP-guided treatment. Mean follow-up was 14.8 months. All-cause mortality (HR 1.03; 95% CI 0.81-1.32; p=0.79; figure 1A), cardiovascular death (HR 1.33; 95% CI 0.72-2.47; p=0.36; figure 1B), and the composite outcome of HF hospitalization or cardiovascular death (HR 0.92; 95% CI 0.77-1.11; p=0.4; figure 1C) were not significantly different between groups.Conclusion:These findings suggest that NP-guided therapy does not reduce mortality and heart failure readmissions in the management of patients with acute decompensated heart failure.
Abstract 4117365: Effect Of Renal Denervation In Combination With Cardiac Ablation On The Recurrence Of Atrial Fibrillation: A Systematic Review and Meta-Analysis
Circulation, Volume 150, Issue Suppl_1, Page A4117365-A4117365, November 12, 2024. Background:Atrial fibrillation(AF) is the most common cardiac arrhythmia, affecting millions globally. Despite various treatments, recurrence remains high, especially among those with drug-resistant hypertension.Aim:To evaluate the efficacy of combining Renal Denervation and Cardiac Ablation compared to Cardiac Ablation Alone in reducing AF recurrence.Methods:A systematic review and meta-analysis were conducted following the PRISMA-2020 guidelines, A search for randomized controlled clinical trials was carried out in PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and ScienceDirect until March 2024. Specifically, about adult patients aged 18 years and above diagnosed with AF and drug-resistant hypertension undergoing renal denervation and or cardiac ablation. The primary outcome was the recurrence of AF. The secondary outcomes were effects on systolic blood pressure, diastolic blood pressure, cardiovascular structural changes, glomerular filtration rate (eGFR). In addition, periprocedural events and major complication events. Dichotomous outcomes were calculated using relative risk (RR) with 95% confidence interval (CI). For continuous variables, the results were shown considering the mean difference (MD) and standard deviation with 95% CI.Results:From 409 studies identified, 8 studies and 695 patients were included. Meta-analysis showed a significant reduction in atrial fibrillation recurrence with the combination therapy (HR 0.66 [95% CI=0.55 – 0.79], p=0.00001). Blood pressure outcomes were superior in the combination group, with reductions in both systolic (MD = -9.66 mmHg [95% CI: -13.89, -5.42], p=0.00001) and diastolic pressures (MD = -7.09 mmHg [95% CI: -13.67, -0.50], p=0.003). Cardiovascular structural changes, such as left atrial size (RR 2.85 [95% CI: 2.13, 3.81], p=0.00001) and interventricular septal thickness (MD = -1.15 [95% CI: -1.85, -0.44], p=0.003), also favored the combination therapy. Kidney function, measured by eGFR was better preserved (MD = -10.34 [95% CI: -13.39, -7.28], p
Abstract 4142671: Machine-learning versus traditional risk scores for predicting clinical outcomes after coronary artery bypass graft surgery: a systematic review and meta-analysis
Circulation, Volume 150, Issue Suppl_1, Page A4142671-A4142671, November 12, 2024. Background:Coronary Artery Bypass Graft Surgery (CABG) is the most commonly performed operation in cardiac surgery and results from isolated CABG are used as benchmark to rate cardiac surgery programs in the US by the Society of Thoracic Surgeons (STS). Accurate and reliable mortality risk prediction of CABG patients is essential for developing targeted treatment strategies. Traditional risk scores such as the STS score and EuroSCORE II offer moderate discriminative value, and have limited utility in predicting outcomes for high-risk patients. Machine learning (ML) models have emerged as an alternate method that may offer improved risk assessment. This study aims to compare machine learning models with traditional risk scores for predicting all-cause mortality in patients undergoing CABG.Methods:PubMed, EMBASE, Web of Science and Cochrane databases were searched until 18thMay 2024 for studies comparing ML models with traditional statistical methods for event prediction of CABG patients. The primary outcome was comparative discrimination measured by C-statistics with 95% confidence intervals between ML models and traditional methods in estimating the risk of all-cause mortality. A secondary aim was to compare model calibration between ML models and traditional risk scores, adhering to guidelines for predictive algorithm comparisons.Results:A total of 27 studies were included (568,190 patients). The summary C-statistic of all ML models across all endpoints was 0.82 (95% CI, 0.78-0.85), compared to traditional methods 0.73 (95% CI, 0.70-0.75). The difference in C-statistic between all ML models and traditional methods was 0.09 (p
Abstract 4147717: Sodium Glucose Cotransporter 2 Inhibitors on Chronic Heart Failure with Reduced Ejection Fraction in Adult Congenital Heart Disease Patients: A Systematic Review and Meta-analysis
Circulation, Volume 150, Issue Suppl_1, Page A4147717-A4147717, November 12, 2024. Background:SGLT2 inhibitors have demonstrated efficacy in reducing cardiovascular death and hospitalization and are recommended as first-line therapy for hear failure (HF) in adults due to acquired heart diseases. Our study aimed to assess the safety, tolerability, and outcomes of HF patients with adult congenital heart disease (ACHD) treated with SGLT2 inhibitors.Methods:We conducted a comprehensive search of three major databases—PubMed, Scopus, and Embase—and collected articles on the use of SGLT2 inhibitors for HF in ACHD patients who were already receiving angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), angiotensin receptor neprilysin inhibitors (ARNI), beta-blockers (BB), and mineralocorticoid antagonists (MRA). We excluded articles related to acute decompensated HF and HF with preserved ejection fraction. The primary outcome was the change in NYHA functional class (FC). Secondary outcomes included changes in B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) levels, as well as body weight. Additionally, we evaluated the safety and tolerability of SGLT2 inhibitors in ACHD HF patients. A pooled effect size was calculated based on mean differences (MD) or log odds ratio (LogOR).Results:Our meta-analysis included 9 studies with a total of 287 patients aged 19 to 67 (median 37.5 years) (Table). When SGLT2 inhibitors were added to combined therapies, they significantly improved NYHA FC (LogOR: 1.3, 95% CI: 0.37–2.23, p=0.01) (Figure 1A), decreased NT-proBNP (MD -0.43, 95% CI -0.70 to -0.16, p=0.00) (Figure 1B), were associated with a reduction in systolic blood pressure (MD = -0.32, 95% CI: -0.51 to 0.14, p=0.00) (Figure 1C), and led to an elevation of creatinine (Cr) levels (MD = 0.18, 95% CI -0.0 to 0.36, p=0.06) (Figure 1D). Only 4 patients experienced urinary tract infections (UTIs), and none had hypoglycemia or ketoacidosis.Conclusion:Our meta-analysis demonstrates that SGLT2 inhibitors improve NYHA FC, decrease NT-proBNP, and are well-tolerated with safety features similar to adult HF clinical trials when added to combination HF therapies including ACEI/ARB/ARNI, BB and MRA. Future prospective studies are needed to assess long-term clinical outcomes in ACHD patients with HF.