Impact of Gender-Affirming Hormonal Therapy on Cardiovascular Risk Factors in Transgender Health: An Updated Meta-Analysis.

Background: Gender-affirming hormone therapy (GAHT) is common among transgender individuals, but its impact on lipid profile and cardiovascular health is not well studied. Objectives: The authors performed a systematic review and meta-analysis of existing literature to assess the impact of GAHT on lipid profiles and metabolic cardiovascular risk factors in transgender individuals. Methods: Online databases including MEDLINE/PubMed, Embase, and Cochrane Central registry were searched to find studies on lipid profile changes in women who are transgender, also referred to as transfeminine (TF), and men who are transgender, also referred to as transmasculine (TM) before and after GAHT. Baseline comorbidities were analyzed using descriptive statistics, and R-statistical software was used to analyze the mean difference in lipid profile change between the two cohorts (pre- and post-GAHT therapy) including transgender patients. Results: Overall, 1,241 TM and 992 TF patients were included from 12 observational studies and 12 randomized controlled trials. The mean age among TM and TF was 28 years and 30 years, respectively. The mean follow-up duration (including pre- and post-GAHT therapy) was 28 months in TM patients and 39 months in TF patients. When compared to baseline measures, TM patients had a significant increase in low-density lipoprotein, triglyceride levels, and total cholesterol while high-density lipoprotein levels decreased. In TF patients, there was a significant increase in triglyceride levels. Conclusions: GAHT affects lipid profiles in transgender patients; however, additional studies are needed to determine how these changes impact clinical outcomes.

Outcomes after transcatheter aortic valve replacement in cancer survivors with prior chest radiation therapy: an updated systematic review and meta-analysis.

Clinical outcomes for TAVR in cancer survivors with prior chest radiation therapy (C-XRT) who develop symptomatic aortic-valve stenosis are not adequately assessed in major clinical trials leading to conflicting results. Hence, we conducted this meta-analysis to evaluate the, safety, efficacy, and mortality outcomes of cancer survivors with prior C-XRT undergoing TAVR. MEDLINE and Scopus were searched up to March 2024. Observational studies and randomized controlled trials comparing severe aortic stenosis patients with and without prior C-XRT undergoing TAVR with at least one outcome of interest were shortlisted. Data were analyzed using random-effects model to derive weighted mean differences, and risk ratios with 95% confidence intervals. Six studies with 6,191 patients (278 C-XRT and 5,913 no-C-XRT) were included. All-cause mortality at 30-day (RR 1.63, p = 0.12) and 1-year interval (RR 1.59, p = 0.08) showed no significant differences with prior C-XRT versus no-C-XRT. Worsening CHF was the only post-procedural safety outcome significantly higher in patients with prior C-XRT (RR 1.98, p = 0.0004) versus no- C-XRT. The efficacy end-points i.e., improvement in LVEF (MD 1.24; -0.50, 2.98), and aortic valve gradient (MD -0.63; -1.32, 0.05) were not significantly different. TAVR has similar all-cause mortality, efficacy and safety (except CHF worsening) among cancer survivors with and without a prior history of C-XRT.

Beta-Blocker Usage in Patients With Heart Failure With Reduced Ejection Fraction During Acute Decompensated Heart Failure Hospitalizations.

Background: Acute decompensated heart failure accounts for more than 1 million hospitalizations in the United States every year. Beta-blockers are a first-line agent for patients experiencing heart failure with reduced ejection fraction, but beta-blocker use in patients hospitalized for acute decompensated heart failure remains low. We conducted an analysis of the existing evidence and guidelines to determine the conditions for prescribing beta-blockers to patients with acute decompensated heart failure. Methods: We searched the PubMed database for studies from 2004 to 2024 that included the search terms "beta blockers" and "acute decompensated heart failure." We included studies in which beta-blockers were used in patients with heart failure with reduced ejection fraction and excluded studies that did not study beta-blockers directly. We compiled recommendations from professional societies regarding beta-blocker usage-both for outpatients with heart failure with reduced ejection fraction and for patients hospitalized with acute decompensated heart failure. Results: Studies consistently demonstrated lower rates of mortality and rehospitalization when beta-blocker therapy was maintained for patients with heart failure with reduced ejection fraction who were already on beta-blocker therapy. Conversely, withdrawal of beta-blocker therapy was associated with increased in-hospital and short-term mortality. We summarized our findings in a guideline-based flowchart to help physicians make informed decisions regarding beta-blocker therapy in patients with acute decompensated heart failure. Based on the evidence, beta-blockers should be initiated at a low dose in patients with heart failure with reduced ejection fraction who have never been on beta-blockers, provided the patient is hemodynamically stable. Conclusion: Our research and our guideline-based flowchart promote guideline-directed use of beta-blockers to improve the outcomes of patients with heart failure with reduced ejection fraction.

Rising mortality related to cardiovascular disease and prostate cancer amongst older men across the United States.

OBJECTIVE: There is a significant association between cardiovascular diseases (CVD) and prostate cancer (PCa), leading to high mortality. This study evaluates the trends in mortality associated with CVDs and PCa among older (≥ 65 years) men in the United States (US). METHODS: This analysis utilized the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER). The analysis of Multiple Cause of Death Files was carried out from 1999 to 2019 to identify fatalities with CVD and PCa listed as either contributory or underlying causes of death. Crude and age-adjusted mortality rates (AAMRs) per 100,000 populations for variables such as year, race and ethnicity, and geographic regions were determined. To assess annual percent change (APC), a Joinpoint regression program was employed. RESULTS: Overall AAMR was 54.3 in 1999 and 34.6 in 2019. After a decline in AAMR from 1999 to 2015, an alarming rise in mortality was observed until 2019. Mortality rates were highest among Non-Hispanic (NH) Black and African American men (74.9). Geographically, the highest mortalities were witnessed in the West (46.4) and non-metropolitan areas (44.6). States with AAMRs ranking in the 90th percentile were Nebraska, California, North Dakota, the District of Columbia, and Mississippi. CONCLUSION: After decreasing death rates associated with CVD and PCa from 1999 to 2015, a reversal in the trend was observed from 2015 to 2019. Addressing this increase in death rates, especially among the vulnerable population, requires focused attention and targeted strategies to implement necessary safeguards in the upcoming years.

Efficacy and safety of aspirin plus clopidogrel versus aspirin alone in ischemic stroke or high-risk transient ischemic attack: A meta-analysis of randomized controlled trials.

Background: Antiplatelet therapy plays an important role in reducing the risk of stroke recurrence in patients with mild ischemic stroke or high-risk transient ischemic attack (TIA). However, data regarding the effectiveness and safety of using aspirin plus clopidogrel in dual antiplatelet therapy (DAPT) compared to aspirin alone in mild ischemic stroke is limited. Methods: PubMed/MEDLINE, Embase, Cochrane Library, and ClinicalTrials.gov were searched for randomized controlled trials (RCTs) that compared DAPT to aspirin alone started within 72 hours in mild ischemic stroke or high-risk TIA. We used a random effects model to pool risk ratios (RRs) along with 95% CIs for clinical outcomes. Results: Four RCTs with 16,547 patients were included in this study. DAPT significantly reduced the risk of recurrent stroke by 26% (RR: 0.74; 95% CI: 0.67-0.83; p < 0.00001), ischemic stroke by 28% (RR: 0.72; 95% CI: 0.65-0.80; p < 0.00001), and major adverse cardiovascular events (MACE) by 24% (RR: 0.76; 95% CI: 0.68-0.84; p < 0.00001) compared to aspirin monotherapy. However, DAPT was associated with a significantly increased risk of moderate or severe bleeding (RR: 1.88; 95% CI: 1.10-3.23; p = 0.02) compared to aspirin alone. No significant differences were observed for hemorrhagic stroke (RR: 1.77; 95% CI: 0.96-3.29; p = 0.07), all-cause mortality (RR: 1.25; 95% CI: 0.87-1.80; p = 0.23), cardiovascular mortality (RR: 1.38; 95% CI: 0.81-2.33; p = 0.23), and myocardial infarction (RR: 1.63; 95% CI: 0.77-3.46; p = 0.20). Conclusion: DAPT involving aspirin plus clopidogrel reduces stroke recurrence and MACE but can lead to an increased risk of moderate or severe bleeding compared to aspirin monotherapy. (PROSPERO ID: CRD42024499310).

Clinical Outcomes of Percutaneous Coronary Intervention in Amyloidosis, Sarcoidosis, and Hemochromatosis.

Background: Infiltrative diseases (IDs), including amyloidosis, sarcoidosis, and hemochromatosis, are characterized by abnormal cellular infiltration in multiple organs, including the heart. The prognosis of percutaneous coronary intervention (PCI) patients with underlying IDs has not been well-studied. We evaluated the prevalence of IDs in patients undergoing PCI and their association with post-PCI outcomes. Methods: The National Inpatient Sample (NIS) 2016-2020 database was used to identify PCI patients with ICD-10 codes for a retrospective analysis. PCI patients were then divided into those with and without underlying IDs, which included amyloidosis, sarcoidosis, and hemochromatosis. Multivariable logistic regression was performed for composite post-PCI outcomes analyses. Results: Among 2,360,860 patients admitted to undergo PCI, 7855 patients had underlying IDs. The highest prevalence was observed for sarcoidosis (0.2%) followed by hemochromatosis (0.07%) and amyloidosis (0.04%). Underlying amyloidosis was associated with worse composite post-PCI outcomes (odds ratio [OR], 1.6; 95% CI, 1.1-2.44; P = .02), including higher in-hospital mortality (OR, 1.9; 95% CI, 1.1-3.4; P = .04), higher risk of intra/post-PCI stroke (OR, 4.0; 95% CI, 1.1-16.0; P = .04), but not major bleeding (OR, 2.2; 95% CI, 0.97-5.03; P = .058). In contrast, underlying sarcoidosis (OR, 1.1; 95% CI, 0.87-1.41; P = .4), and hemochromatosis (OR, 1.18; 95% CI, 0.77-1.8; P = .44) were not associated with composite post-PCI outcomes. Amyloidosis patients undergoing PCI also had higher hospitalization charges ($212,123 vs $141,137; P = .03) and longer length of stay (8.2 vs 3.9 days; P < .001). Conclusions: Underlying amyloidosis was associated with worse post-PCI outcomes including higher in-hospital mortality, intra/post-PCI stroke, and socioeconomic burden. A multidisciplinary approach and future studies are needed to investigate the screening and treatment strategies in these patients.

Cerebral embolic protection for stroke prevention during transcatheter aortic valve replacement.

INTRODUCTION: Cerebral Embolic Protection Device (CEPD) captures emboli during Transcatheter Aortic Valve Replacement (TAVR). With recently published pivotal trials and multiple cohort studies reporting new data, there is a need to re-calibrate available statistical evidence. METHODS: A systematic literature search was conducted across databases from inception till February 2023. Dichotomous outcomes were pooled using Odds Ratio (OR), while continuous outcomes were pooled using Standardized Mean Difference (SMD) along with 95% corresponding intervals (95% CIs). RESULTS: Data was included from 17 studies (7 RCTs, 10 cohorts, n = 155,829). Use of CEPD was associated with significantly reduced odds of stroke (OR = 0.60, 95% CI = 0.43-0.85, p = 0.003). There was no significant difference in disabling stroke (p = 0.25), non-disabling stroke (p = 0.72), and 30-day mortality (p = 0.10) between the two groups. There were no significant differences between the two groups for Diffusion-Weighted Magnetic Resonance Imaging (DW-MRI) findings, acute kidney injury, risk of pacemaker implantation life-threatening bleed, major bleed, minor bleed, worsening National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) and vascular complications (p > 0.05). CONCLUSIONS: The use of CEPD during TAVR reduced the incidence of all-stroke (p = 0.003); however, there were no significant differences in any of the other pooled outcomes (p > 0.05). REGISTRATION: The protocol of this meta-analysis was registered with the Open Science framework [https://doi.org/10.17605/OSF.IO/7W564] before data acquisition was started.

Meta-Analysis Comparing Drug-Coated Balloon Versus Plain Old Balloon Angioplasty for In-Stent Restenosis of Coronary Arteries.

Despite the advent of newer stents, in-stent restenosis has been a persistent and formidable challenge. Trials have demonstrated the superiority of drug-coated balloons over plain old balloon angioplasty. A recent AGENT IDE PRESTO (Prevention of REStenosis with Tranilast and its Outcomes) trial highlighted the need for a more comprehensive understanding; therefore, we conducted a meta-analysis to elucidate their respective clinical outcomes. A literature search was conducted by 2 investigators (SS and MH) using MEDLINE (EMBASE and PubMed) using a systematic search strategy by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) until November 1, 2023. CRAN-R software was used for statistical analysis. The quality assessment was performed using the Cochrane Risk of Bias tool (Supplementary Table 5). We included 6 studies with a total of 1,171 patients. Our analysis showed decreased odds of multiple outcomes with statistically significant results, including target vessel revascularization (odds ratio [OR] 0.33, confidence interval [CI] 0.19 to 0.57), target vessel failure (OR 0.30, CI 0.09 to 0.99), target lesion revascularization (OR 0.22, CI 0.10 to 0.46), restenosis (OR 0.1343, CI 0.06 to 0.27), and major adverse cardiac events (OR 0.2 CI 0.12 to 0.37). Although myocardial infraction and all-cause mortality showed decreased odds with all-cause mortality at 0.8 (95% CI 0.363 to 2.09), and myocardial infarction at 0.6 (95% CI 0.0349 to 1.07), the reductions did not reach statistical significance. Our analysis by scrutinizing 6 randomized controlled trials favored drug-coated balloons over plain old balloon angioplasty. However, extensive research for deeper understanding cannot be overemphasized.

Gender-based disparities in outcomes of coronary bifurcation stenting in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis.

INTRODUCTION: Around 15-20% of lesions necessitating percutaneous coronary interventions (PCI) are attributed to coronary bifurcation lesions. We aim to study gender-based differences in PCI outcomes among bifurcation stents. METHODS: 3 studies were included after thorough systematic search using MEDLINE (EMBASE and PubMed). CRAN-R software using the Metabin module was used for statistical analysis. Pooled odds ratios (OR) were calculated using the random effect model and the Mantel-Haenszel method, with a 95% confidence interval (CI) used to determine statistical significance. Heterogeneity was assessed using Higgins I2. RESULT: Women exhibited a higher risk of in-hospital mortality (OR 0.67, 95% CI 0.58-0.76, I2 = 0%, P < 0.0001), post-procedural bleeding (OR 0.53, 95% CI 0.47-0.6, I2 = 0%, P < 0.0001) and post-procedure stroke (OR 0.72, 95% CI 0.52-1.0, I2 = 0%, P < 0.06) as compared to men. However, there were no significant differences in terms of myocardial infarction (OR 0.84, 95% CI 0.22-3.27, I2 = 49.4%, P < 0.80) and cardiac tamponade (OR 0.63, 95% CI 0.06; 5.72, I2 = 0%, P < 0.6821) in both groups. CONCLUSION: Our study reveals a noteworthy increase in in-hospital mortality in women, which could be attributed to a higher rate of major bleeding, advanced age, increased co-morbidities, and complex pathophysiology of the lesion in comparison to men. Further studies are required to gain a better understanding of the precise mechanisms thus enhancing procedural outcomes.

Impact of frailty index on cardiovascular outcomes and readmissions of patent foramen ovale closure procedure: a propensity matched national analysis.

BACKGROUND: Transcatheter patent foramen ovale (PFO) occluder device is a procedure mostly performed to prevent secondary stroke as a result of paradoxical emboli traversing an intracardiac defect into the systemic circulation. The complications and outcomes following the procedure remain poorly studied. We aimed to investigate morbidity and mortality associated with occluder device procedures using hospital frailty index score stratification. METHODS: The Nationwide Readmission Database was employed to identify patients admitted for PFO closure from 2016 to 2020. Two groups divided by index frailty score were compared to report adjusted odds ratio (aOR) for primary and secondary cardiovascular outcomes. Outcomes included in-hospital mortality, acute kidney injury, acute ischemic stroke, and post-procedure bleeding. Statistical analysis was performed using STATA v.17. RESULTS: Of the 2,063 total patients who underwent the procedure, 45% possessed intermediate to high frailty scores while the other 55% had low frailty scores. The first cohort had higher odds of in-hospital mortality (aOR 6.3, 95% CI 2.05-19.5), acute kidney injury (aOR 17.6, 95% CI 9.5-32.5), and stroke (aOR 3.05, 95% CI 1.5-5.8) than the second cohort. There was no difference in the incidence of post-procedural bleeding and cardiac tamponade and 30/90/180-day readmission rates between the two cohorts. Hospitalizations in the first cohort were associated with a higher median length of stay and total cost. CONCLUSION: High to intermediate frailty scores may predict an increased risk of in-hospital mortality in patients undergoing PFO occluder device procedures.

Comparison of Drug-Coated Balloons With Drug-Eluting Stents in Patients With In-Stent Restenosis: A Systematic Review and Meta-Analysis.

In-stent restenosis (ISR) is the gradual narrowing of the stented coronary segment, presenting as angina or leading to an acute myocardial infarction. Although its incidence has decreased with the use of newer drug-eluting stents (DES), it still carries significant mortality and morbidity risks. We compared the 2 most common interventions for managing DES-related ISR: drug-coated balloons (DCBs) and DES. Electronic databases were searched to identify all randomized controlled trials comparing DCB with DES in patients with DES-ISR. The Mantel-Haenszel method with a random-effects model was used to calculate pooled risk ratios. Five trials comprising 1,100 patients (577 in DCB and 523 in DES group) were included in the final study. The mean follow-up was 42 months. DCB was found to have a higher risk for target lesion revascularization (risk ratio 1.41, p = 0.02) compared with DES. No difference was observed in all-cause mortality, target vessel revascularization, myocardial infarction, or stroke between the 2 intervention arms. In conclusion, management of DES-ISR with DCB has a higher risk of target lesion revascularization compared with re-stenting with DES. The 2 therapeutic interventions are comparable in terms of efficacy and safety profile.

Temporal Trends in the Outcomes of Percutaneous Coronary Intervention With Zotarolimus Eluting Stents Versus Everolimus Eluting Stents: A Meta-Analysis of Randomized Controlled Trials.

INTRODUCTION: Long-term follow-up results of various trials comparing Zotarolimus eluting stents (ZES) with Everolimus eluting stents (EES) have been published recently. Additionally, over the last decade, there have been new trials comparing the ZES with various commercially available EES. We aim to conduct an updated meta-analysis in light of new evidence from randomized controlled trials (RCTs) to provide comprehensive evidence regarding the temporal trends in the clinical outcomes. METHODS: A comprehensive literature search was conducted across PubMed, Cochrane, and Embase. RCTs comparing ZES with EES for short (<2 years), intermediate (2-3 years), and long-term follow-ups (3-5 years) were included. Relative risk was used to pool the dichotomous outcomes using the random effects model employing the inverse variance method. All statistical analysis was conducted using Revman 5.4. RESULTS: A total of 18 studies reporting data at different follow-ups for nine trials (n = 14319) were included. At short-term follow-up (<2 years), there were no significant differences between the two types of stents (all-cause death, cardiac death, Major adverse cardiovascular events (MACE), target vessel myocardial infarction, definite or probable stent thrombosis or safety outcomes (target vessel revascularization, target lesion revascularization, target vessel failure, target lesion failure). At intermediate follow-up (2-3 years), EES was superior to ZES for reducing target lesion revascularization (RR = 1.28, 95% CI = 1.05-1.58, p < 0.05). At long-term follow-up (3-5 years), there were no significant differences between the two groups for any of the pooled outcomes (p > 0.05). CONCLUSION: ZES and EES have similar safety and efficacy at short, intermediate, and long-term follow-ups.

Neutrophil to lymphocyte ratio as a prognostic marker for cardiovascular outcomes in patients with ST-segment elevation myocardial infarction after percutaneous coronary intervention: A systematic review and meta-analysis.

BACKGROUND: Neutrophil to lymphocyte ratio (NLR) has been considered a prognostic biomarker of mortality and other major cardiac events. This study investigates NLR's efficacy in predicting in-hospital and long-term outcomes in patients with ST-segment elevated myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). METHODS: Electronic databases (PUBMED, Cochrane CENTRAL, ERIC, Embase, Ovid, and Google Scholar) were searched till June 2022 to identify studies having STEMI patients who underwent PCI. Risk ratios and mean differences (MDs), along with their corresponding 95% confidence intervals (Cis) and standard deviations (SDs), were pooled using a random-effect model. This meta-analysis has been registered on Prospero (ID: CRD42022344072). RESULTS: A total of 35 studies with 28,756 patients were included. Pooled estimates revealed an increased incidence of primary outcomes; in-hospital all-cause mortality (RR = 3.52; 95% CI = 2.93-4.24), long-term all-cause mortality (HR = 1.07; 95% CI = 1.00-1.14), (RR = 3.32; 95% CI = 2.57-4.30); in-hospital cardiovascular mortality (RR = 2.66; 95% CI = 2.04-3.48), long-term cardiovascular mortality (RR = 6.67; 95% CI = 4.06-10.95); in-hospital major adverse cardiovascular events (MACE) (RR = 1.31; 95% CI = 1.17-1.46), long-term MACE (RR = 2.92; 95% CI = 2.16-3.94); length of hospital stay (WMD = 0.60 days; 95% CI = 0.40-0.79) in patients with high NLR compared to those with a low NLR. CONCLUSION: NLR might be a valuable tool for prognostication (in-hospital) and stratification of patients with STEMI who underwent PCI.

Drug-eluting stent vs. Balloon angioplasty in patients with in-stent restenosis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

INTRODUCTION: In-stent restenosis (ISR) is seen in up to 20% of cases and is the primary cause of percutaneous coronary intervention (PCI) failure. With the use of re-stenting with a drug-eluting stent (DES), plain old balloon angioplasty (BA) use is decreasing. We aim to compare the efficacy and safety profile of DES over BA in the management of ISR. METHODS: Electronic databases were searched to identify all randomized controlled trials (RCTs) comparing DES to BA for coronary ISR. The mantel-Haenszel method with a random effects model was used to calculate pooled risk ratios (RR). RESULTS: Four trials comprising 912 patients (543 in DES and 369 in the BA group) were included in the final study. The mean follow-up was 45 months. DES was found to be superior with a lower requirement of target vessel revascularization (TVR) (RR: 0.45, 95% CI: 0.31-0.64, p-value <0.0001), and target lesion revascularization (TLR) (RR: 0.59, 95%CI: 0.44-0.78, p-value 0.0002) compared to BA. However, all-cause mortality, cardiovascular mortality, incidence of myocardial infarction (MI), and target lesion thrombosis were not different between the two intervention arms. CONCLUSION: DES was found to be superior to BA for the management of coronary ISR with a reduction in the risk of TLR and TVR. No difference in mortality, risk of MI, or target lesion thrombosis was observed between the two interventions.

Readmission Trends and Outcomes of Transcatheter Edge-to-Edge Repair of Mitral Regurgitation With and Without Anemia.

BACKGROUND: Anemia is associated with worse clinical outcomes in cardiac patients. We aim to investigate the clinical outcomes and readmission rates in anemic patients undergoing transcatheter edge-to-edge repair (TEER) for severe mitral valve regurgitation (MR). METHODS: The National Readmissions Database (NRD) from 2015 to 2018 was queried using the ICD-10 codes to identify patients admitted for TEER. Patients were divided into anemic and non-anemic sub-groups. Univariate and multivariate analyses were performed. Cardiovascular outcomes were assessed between cohorts at index admission and readmissions at 30, 90, and 180 days. STATA v.17 was used for analysis (StataCorp LLC, Texas, USA). RESULTS: Our final cohort included 28,995 patients who had undergone TEER in the United States between 2016 and 2019. About 1,434 (4.9%) had a diagnosis of anemia. The mean age of patients who had TEER with anemia and TEER without anemia was 76.9 ± 10.8 vs. 77.7 ± 10.2, respectively. In the adjusted model, anemic patients had higher odds of acute kidney injury (AKI) (aOR 2.21; 95% [CI 1.81-2.6; p<0.001]), HF (aOR 1.75; 95% [CI 1.28-2.3; p<0.001]), myocardial infarction (MI) (aOR 1.54; 95% [CI 1.01-2.33; p<0.041]), major adverse cardiac and cerebrovascular events (MACCE) (aOR 1.72; 95% [CI 1.2-9-2.3; p<0.001]), and net adverse event (aOR 1.85; 95% [CI 1.32-2.59; p<0.001]). The anemic group's readmission rate was overall higher at 30, 90, and 180 days from 2016 to 2019. CONCLUSION: Anemia was associated with increased adverse clinical outcomes and more extended hospital stays in patients with anemia who had undergone TEER procedures compared to the non-anemic group.

Assessing the Efficacy of RADPAD Protection Drape in Reducing Radiation Exposure to Operators in the Cardiac Catheterization Laboratory: A Systematic Review and Meta-Analysis.

One of the leading environmental hazards, ionizing radiation, is linked to several detrimental health consequences in the body. RADPAD (Worldwide Innovations & Technologies, Inc., Kansas City, Kansas) is a sterile, lead-free, lightweight, disposable radiation protection shield. We conducted a systematic review and meta-analysis to determine the effectiveness of RADPAD protection drapes in the cardiac catheterization lab and how they can aid interventional cardiologists in becoming subjected to less scatter radiation. PubMed, Embase, and Google Scholar were searched for studies discussing the efficacy of RADPAD protection drapes in reducing radiation exposure to operators in the cardiac catheterization laboratory. A random-effects model was used to pool odds ratios (ORs) and 95% confidence intervals (CIs) for endpoints: primary operator exposure dose, dose area product (DAP), relative exposure, and screening time. Our analysis included 892 patients from six studies. Compared to the No-RADPAD group, primary operator exposure dose (E) was significantly lower in the RADPAD group (OR: -0.9, 95% CI: -1.36 to -0.43, I2 = 80.5%, p = 0.0001). DAP was comparable between both groups (OR: 0.008, 95% CI: -0.12 to -0.14, I2 = 0%, p = 0.9066). There was no difference in the relative exposure (E/DAP) (OR: -0.47, 95% CI: -0.96 to 0.02, I2 = 0%, p = 0.90) and screening time (OR: 0.13, 95% CI: 0.08 to 0.35, I2 = 0%, p = 0.22) between the two groups. The interventional cardiology laboratory is exposed to significantly less scatter radiation during procedures owing to the RADPAD protective drape. Consequently, all catheterization laboratories could be advised to employ RADPAD protective drapes.

Cardiovascular outcomes of emergent vs elective transcatheter aortic valve replacement in severe aortic stenosis: regression matched meta-analysis.

BACKGROUND: Transcatheter aortic valve replacement (TAVR) has been highly increased as the recommended option for patients with a high surgical risk. This study aims to commit a systematic review and meta-analysis to assess the outcomes in severe aortic stenosis patients following emergency transcatheter aortic valve replacement (emergent TAVR) compared to elective TAVR or eBAV followed by elective TAVR. METHODS: We conducted a systematic literature search of PubMed, Embase, Cochrane CENTRAL, CINAHL, Science Direct, and Google Scholar. We included nine studies in the latest analysis that reported the desired outcomes. Outcomes were classified into primary outcomes: 30-day all-cause mortality and 30-day readmission rate, and secondary outcomes, which were further divided into (a) peri-procedural outcomes, (b) vascular outcomes, and (c) renal outcomes. Statistical analysis was performed using Stata v.17 (College State, TX) software. RESULTS: A total of 44,731 patients with severe aortic stenosis were included (emergent TAVR n = 4502; control n = 40045). 30-day mortality was significantly higher in the emergent TAVR group (OR: 2.62; 95% CI = 1.76-3.92; P < 0.01). Regarding post-procedural outcomes, the length of stay was significantly higher in the emergent TAVR group (Hedges's g: +4.73 days; 95% CI = +3.35 to +6.11; P < 0.01). With respect to vascular outcomes, they were similar in both groups. Regarding renal outcomes, both acute kidney injury (OR: 2.52; 95% CI = 1.59-4.00; P < 0.01) and use of renal replacement therapy (OR: 2.33; 95% CI = 1.87-2.91; P < 0.01) were significantly higher in emergent TAVR group as compared to the control group. CONCLUSION: Our study demonstrated that despite increased 30-day mortality and worse renal outcomes, the post-procedural outcomes were similar in emergent and elective TAVR groups. The increased mortality and worse renal outcomes are likely due to hemodynamic instability in the emergent group. The similarity of post-procedural outcomes is evidence of the safety of TAVR even in emergent settings.