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Background and aims: The paucity of large-scale data exploring the effect of prior bariatric surgery on recurrent stroke outcomes in older individuals with obesity who survived a stroke led us to address the gap, with an emphasis on the risk of recurrent stroke and its trends. Methods: Retrospective analysis of the National Inpatient Sample data from 2016 to 2019. Older individuals with obesity who survived a stroke (>65 years) and had a recurrent acute ischemic stroke (AIS) hospitalization, with or without prior bariatric surgery (PBS), were identified using ICD-10 codes. Recurrent stroke trends, demographic characteristics, and comorbidities between the cohorts were compared. Results: Analyzing 643,505 older individuals with obesity who survived a stroke, we identified that 11,820 had undergone PBS. Both groups (no PBS vs. PBS) were predominantly female (59.7 % vs. 73.7 %), identified as white (76.5 % vs. 83.8 %), and covered by Medicare (91.7 % vs. 90.7 %). Diabetes, hyperlipidemia, prior myocardial infarction, and peripheral vascular diseases were more common in those without PBS. In contrast, tobacco use disorder, drug abuse, and valvular diseases were more common in those with PBS. There was no significant difference in the prevalence of hypertension between groups.Between 2016 and 2019, recurrent AIS hospitalizations were less frequent in the PBS group (4 %-2.9 %, p = 0.035) while remaining stable in the other group (4.4 %-4.2 %, p = 0.064). The risk of recurrent AIS hospitalization was less frequent in the PBS cohort (aOR: 0.77, 95 % CI: 0.60-0.98). Conclusion: PBS in older individuals with obesity who survived a stroke was associated with a 23 % lower risk of recurrent AIS hospitalization with a decreasing trend of prevalence since 2016. These findings could influence clinical practice and contribute to developing secondary prevention strategies for recurrent stroke among these patients.
ABSTRACT
INTRODUCTION: Hypertension is associated with left ventricular hypertrophy/enlargement/fibrosis and atrial ectopic rhythm, leading to an increased risk of Atrial Fibrillation (AF). We aimed to stratify the effect of Angiotensin Converting Enzyme Inhibitors (ACEi) and Angiotensin Receptor Blockers (ARB) on the risk of AF. METHODS: PubMed, Scopus, and Google Scholar databases were screened, and cross-citation was conducted for studies reporting AF in hypertensive patients on ACEi and ARB. Of 145 studies found till May 2023, 19 were included in this study. Binary random-effects models estimated the pooled odds ratios, I2 statistics assessed heterogeneity and sensitivity analysis was assessed using the leave-one-out method. RESULTS: 153,559 hypertensive patients met the inclusion criteria. For incidental AF, ACEi and ARB showed a significant decrease in both unadjusted (OR 0.75, 95% CI [0.66-0.85], I² = 20.79%, p=0.29) and adjusted risks (OR 0.76, 95% CI [0.62-0.93], I² = 88.41%, p<0.01). In recurrent AF, the unadjusted analysis showed no significant effect (OR 0.89, 95% CI [0.55-1.42], I² = 78.44%, p<0.01), while the adjusted analysis indicated a reduced risk (OR 0.62, 95% CI [0.50-0.76], I² = 65.71%, p<0.01). Leave-one-out sensitivity analysis confirmed these results. CONCLUSIONS: ACEi and ARB considerably decrease the risk of incidental and recurrent AF in hypertensive patients, emphasizing the importance of treating clinical hypertension with these drugs.
ABSTRACT
BACKGROUND: Aortic valve disease is a common and impactful disorder that imposes significant health burdens and is associated with increased mortality rates. Particularly noteworthy is the emergence of transcatheter aortic valve replacement (TAVR), a minimally invasive procedure that has revolutionized the management of aortic valve disease. However, there remain certain unresolved questions and ongoing research regarding the long-term effectiveness and suitability of TAVR in various patient populations, underscoring the need for further investigation and clinical scrutiny. OBJECTIVE: This retrospective analysis aimed to investigate the long-term outcomes and predictors of mortality in 500 patients who underwent transcatheter aortic valve replacement (TAVR). METHODS: This retrospective analysis included individuals who received transcatheter aortic valve replacement (TAVR) at Sri Venkata Sai (SVS) Medical College, Mahabubnagar, Telangana, India, between January 2020 and July 2023. Demographic characteristics, including age, gender, and comorbidities, were recorded, and long-term outcomes after TAVR were assessed, including the incidence of survival rates and major adverse cardiac events (MACE). Predictors of mortality were also identified using Cox proportional hazards regression analysis. RESULTS: The study group exhibited an average age of 75.6 years (standard deviation (SD): 6.8), with 58% male and 42% female patients. Hypertension (74%), coronary artery disease (CAD) (68%), diabetes mellitus (DM) (42%), and chronic kidney disease (CKD) stage ≥ 3 (36%) were prevalent comorbidities. The median follow-up duration was 5.2 years (interquartile range (IQR): 4.3-6.8 years). The overall long-term survival rate after TAVR was 73.5% (95% confidence interval (CI): 69.8%-77.1%). Additionally, MACE occurred in 21% of patients throughout the follow-up period. The cumulative incidence of MACE at one year, three years, and five years was 6.8% (95% CI: 4.2%-9.5%), 14.2% (95% CI: 10.6%-18.7%), and 21.8% (95% CI: 17.3%-26.7%), respectively. The study found that higher age (hazard ratio (HR): 1.08, 95% CI: 1.04-1.12, p < 0.001), male gender (HR: 1.48, 95% CI: 1.15-1.91, p = 0.002), and the presence of CAD (HR: 1.72, 95% CI: 1.29-2.30, p < 0.001) were linked to an elevated risk of mortality. Additionally, diabetes mellitus (HR: 1.39, 95% CI: 1.05-1.85, p = 0.022) and CKD stage ≥ 3 (HR: 1.96, 95% CI: 1.47-2.61, p < 0.001) emerged as notable predictors of mortality. Conversely, a history of prior coronary artery bypass grafting (CABG) (HR: 0.62, 95% CI: 0.46-0.84, p = 0.003) was associated with a reduced risk of mortality. No significant associations were found between mortality and hypertension (HR: 1.12, 95% CI: 0.88-1.43, p = 0.360) or prior percutaneous coronary intervention (PCI) (HR: 1.21, 95% CI: 0.88-1.67, p = 0.245). CONCLUSION: Age, male gender, CAD, DM, and CKD stage ≥ 3 were significant indicators of mortality risk in TAVR patients. Risk stratification and individualized management are crucial in optimizing long-term outcomes following TAVR procedures.