RESUMEN
Introduction: Sarcoidosis is a systemic inflammatory disorder characterised by non-caseating granulomas. Cardiac sarcoidosis (CS) normally causes conduction abnormalities, ventricular arrhythmias, and heart failure. Little is known about the characteristics and impact of sarcoidosis in patients admitted with ST-elevation myocardial infarction (STEMI). This study aims to fill this void. Material and methods: Utilising the National Inpatient Sample (NIS) database (2016-2020), individuals with STEMI were identified and categorised based on sarcoidosis presence whilst adjusting for confounders via logistic regression models. Results: Among 851,290 STEMI patients, 1215 had sarcoidosis. Before propensity matching, sarcoidosis patients were notably different in demographics and comorbidities compared to non-sarcoidosis patients. After propensity score matching (PSM), sarcoidosis patients were found to have a higher incidence of supraventricular tachycardia (SVT) (2.5% vs. 1.3%, p = 0.024) and acute kidney injury (AKI) (23.3% vs. 20.8%, aOR = 1.269, 95% CI: 1.02-1.58, p = 0.033) but a lower incidence of undergoing coronary artery bypass graft (CABG) (5.5% vs. 8.5%, aOR = 0.663; 95% CI: 0.472-0.931, p = 0.018), while no significant disparities were noted in PCI, cardiogenic shock, mortality, or mean length of stay (LOS). Conclusions: Using propensity-matched large real-world data of STEMI patients, sarcoidosis was associated with fewer cases of CABG and a greater incidence of AKI and SVT compared to non-sarcoidosis patients.
RESUMEN
It is important to understand the role of polypills on medication adherence and clinical outcomes in patients with or at high risk of cardiovascular diseases (CVD) to help decision-makers make robust guidelines on using polypills in these people. Therefore, the current meta-analysis was conducted to assess the impact of polypills on medication adherence and clinical outcomes in patients with or at high risk of CVD. The present meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. We searched the electronic databases PubMed, Embase, and the Cochrane Library for randomized control trials (RCTs) from inception to January 1, 2023. The outcomes assessed in the present meta-analysis were adherence to prescribed drugs at the study end, the incidence of cardiovascular events, and change in low-density lipoprotein cholesterol (LDL-C), total cholesterol, and high-density lipoprotein (HDL) from baseline to the study end in mmol/l. A total of six studies were included in the present meta-analysis, with a total sample size of 13139 (6577 in the polypill group and 6562 in the control group). Meta-analysis showed that medication adherence was significantly higher in patients receiving polypills compared to the control group (relative risk (RR): 1.38, 95% confidence interval (CI): 1.22-1.56, p-value: 0.001). The risk of a cardiovascular event was significantly lower in the polypill group (RR: 0.72, 95% CI: 0.63-0.82, p-value: 0.001). No significant differences were found in the changes in LDL-C and total cholesterol between the two groups. This meta-analysis shows a significant impact of polypills on medication adherence. We also found that polypills can reduce the incidence of cardiovascular events in patients with or at high risk of CVD. Our study has also shown that regardless of the history of CVD, polypills play an important role in promoting medication adherence in patients with and without a history of CVD.
RESUMEN
Atrial fibrillation is an irregular heart rhythm, and it is one of the most common cardiac arrhythmias. It is associated with a five times increase in the risk of stroke. Anti-coagulants are prescribed routinely to prevent strokes, especially in patients with atrial fibrillation for many years decreasing the risk of stroke among patients with atrial fibrillation. Non-vitamin K oral anticoagulants especially apixaban and rivaroxaban are frequently used and they are considered to be safe and more effective than warfarin. The aim of this meta-analysis is to compare the efficacy and safety of apixaban and warfarin in preventing stroke among patients with non-valvular arterial fibrillation. The current meta-analysis was conducted using the guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A systematic search was done using databases, including PubMed, EMBASE, and Cochrane Library, with no restrictions on language and year of publication. The current meta-analysis included randomized control trials and non-randomized control trials (prospective and retrospective cohort studies) comparing the efficacy and safety of apixaban and warfarin in preventing stroke in patients with non-valvular atrial fibrillation. The primary efficacy outcome was stroke or systemic embolism while the primary safety outcome was major bleeding events. Overall, nine articles were included in the current meta-analysis with a pooled sample size of 267998 patients with non-valvular atrial fibrillation. The administration of apixaban was associated with a significant decrease in stroke or systemic embolism (RR: 0.77, 95% CI: 0.67-0.90) and major bleeding events (RR=0.63, 95% CI: 0.58-0.68) as compared to warfarin. However, no significant difference was reported in all-cause mortality (RR=0.80, 95% CI: 0.30-2.14) between the two groups. The current meta-analysis concluded that apixaban, compared to warfarin in patients with non-valvular atrial fibrillation showed a reduction in stroke and systemic embolism. Apixaban has also a better safety profile in terms of reduction in overall major bleeding events.
RESUMEN
Sodium-glucose cotransporter-2 (SGLT2) inhibitors are oral diabetes medications that enhance the excretion of glucose by preventing the renal proximal tubules from reabsorbing glucose, which lowers glucose levels in plasma. Currently, studies have shown that SGLT2 inhibitors have beneficial impacts on cardiovascular outcomes, but their effect varies between the individual SGLT2 inhibitors. Thus, the current meta-analysis was conducted to compare the efficacy of dapagliflozin and empagliflozin in preventing cardiovascular events in patients with type 2 diabetes. The current meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. A search of studies comparing cardiovascular events between dapagliflozin and empagliflozin in patients with type 2 diabetes published up to 1 July 2022 was done by two reviewers independently on PubMed, Embase and Cumulated Index to Nursing and Allied Health Literature (CINAHIL). The pre-specified primary endpoints were cardiovascular death, stroke, myocardial infarction and heart failure. Overall four studies were included in this meta-analysis. No significant difference was found in the incidence of myocardial infarction (risk ratio (RR)=0.81, 95% confidence interval (CI): 0.60-1.09), heart failure (RR=0.76, 95% CI: 0.56-1.04), cardiovascular mortality (RR=0.46, 95% CI: 0.18-1.20) and stroke (RR=1.07, 95% CI: 0.84-1.38) between dapagliflozin and empagliflozin. Results have shown that the risk of developing stroke, heart failure, myocardial infarction and cardiovascular death were not significantly different in the two groups.
RESUMEN
Coronary vessel disease (CVD) is a class of diseases that impacts the blood vessels and heart and is one of the leading causes of disability and death. CVD includes cerebrovascular disease and coronary heart disease, both illnesses of the vessels transporting the oxygenated blood to the brain or heart. Colchicine is an inexpensive and old drug with strong anti-inflammatory effects. Numerous randomized control trials (RCTs) have demonstrated the effectiveness of low-dose colchicine for the prevention of severe cardiovascular events without showing any signs of serious adverse effects within the regime of treatment. In the current meta-analysis, we aim to assess the efficacy and safety of colchicine for secondary cardiovascular outcome prevention among patients with clinically proven CVD. The current meta-analysis was carried out using the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. PUBMED, Cochrane, and EMBASE databases were used to search for RCTs comparing colchicine and placebos for the prevention of secondary cardiovascular outcomes. The primary efficacy endpoint was mortality due to cardiovascular disease, stroke, urgent coronary revascularization, and myocardial infarction. Secondary efficacy outcomes included death due to all-cause mortality. Seven RCTs were reviewed, with a pooled sample size of 12114, out of which 6099 were randomized to the colchicine group, and 6015 were randomized to the control group. The decrease in cardiovascular events, including myocardial infarction, stroke, urgent coronary revascularization, and cardiac-related death, was significantly lower in patients randomized to colchicine (p-value<0.05). The incidence of safety outcomes did not vary significantly different between groups (p>0.05). In patients with CVD, compared to standard medical therapy, colchicine significantly decreases the risk of cardiovascular events such as cardiovascular-related death, myocardial infarction, stroke, and urgent coronary revascularizations.
RESUMEN
Pneumonia is a pathological process of interstitial lung tissue and distal airway and alveolar infection and infiltration. SMART-COP (systolic blood pressure, multilobar infiltrates, albumin, respiratory rate, tachycardia, confusion, oxygen, and pH) is a severity score method designed to identify individuals who require intensive respiratory or vasopressor support (IRVS) support due to pneumonia. Therefore, it is important for management decisions in pneumonia. This meta-analysis was conducted to determine the performance of the SMART-COP score in predicting the prognosis and severity of patients presenting with community-acquired pneumonia (CAP). The current meta-analysis was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search was conducted using Medline, Embase, and CINAHL to identify relevant studies assessing the validity of the SMART-COP score in predicting the severity of patients with CAP. Overall, nine studies were included in the current meta-analysis. A pooled sensitivity of the SMART-COP score to predict the use of IRVS is 89% (95% CI: 84%-92%) while its specificity is 68% (95% CI: 65%-70%). The pooled sensitivity of the SMART-COP score to predict 30-day mortality is 92% (95% CI: 89%-94%) while its specificity is 39% (95% CI: 37%-42%). To summarize, SMART-COP is a new, eight-variable instrument that appears to accurately identify patients with CAP who will require IRVS and 30-day mortality. Our findings show that SMART-COP will be a valuable tool for clinicians in accurately predicting illness severity in CAP patients as compared to other scoring systems. SMART-COP can be useful to identify patients who need urgent management.
