The effect of statin on major adverse cardiovascular events and mortality in patients with rheumatoid arthritis - a systematic review and meta-analysis.

OBJECTIVE: The aim of this systematic review and meta-analysis is to assess the effect of statin on major adverse cardiovascular events (MACE) and mortality in patients with RA. MATERIALS AND METHODS: A systematic literature search was performed using PubMed, Scopus, Embase, and Clinicaltrials.gov for studies investigating the effect of statin on MACE and mortality in RA patients up until 6 February 2022. The primary outcome was MACE, which can be defined as nonfatal myocardial infarction (MI), nonfatal presumed ischemic stroke, transient ischemic attack, any coronary or non-coronary revascularization, or cardiovascular death. The pooled effect estimated was reported as hazard ratio (HR). RESULTS: There were 40,307 patients from a total of six studies, comprising of one double-blind placebo controlled randomized controlled trial, four propensity-score matched cohorts, and one observational study included in this meta-analysis. The rate of MACE was lower in RA patients receiving statin [OR 0.67 (95%CI 0.51, 0.89), p=0.005; I2: 21.0%, p=0.29] (Figure 2). Sensitivity analysis using fixed-effect model showed that MACE was lower in the statin group [OR 0.73 (95%CI 0.62, 0.87), p<0.0051 I2: 21.0%, p=0.29]. Mortality was lower in RA patients receiving statin [OR 0.73 (95%CI 0.62, 0.88), p<0.001; I2: 29.0%, p=0.25] (Figure 3). Sensitivity analysis using fixed-effect model showed that mortality was lower in the statin group [OR 0.75 (95%CI 0.66, 0.85), p<0.001 I2: 29.0%, p=0.25]. CONCLUSIONS: This systematic review and meta-analysis showed that statin was associated with reduction of MACE and mortality in patients with RA.

The role of pentoxifylline in preventing contrast-induced nephropathy in coronary angiography/intervention - systematic review, meta-analysis, and meta-regression of randomized controlled trials.

OBJECTIVE: This systematic review and meta-analysis aimed to synthesize the latest evidence on pentoxifylline effect on the contrast-induced nephropathy (CIN) and whether the quality evidence is sufficient to make a definite conclusion MATERIALS AND METHODS: We performed a systematic literature search on topics that assesses pentoxifylline and CIN in coronary angiography/intervention up until 01 April 2021 using PubMed, Scopus, Embase, and hand-sampling. Primary outcome was CIN defined as ≥0.5 mg/dL or 25% rise in the SCr 48 h after procedure. RESULTS: There were a total of 1142 subjects from 6 studies. There was no difference between pentoxifylline and control group in terms of serum creatinine at baseline (p=0.46) and after the procedure (p=0.33). The incidence of CIN was 51/571 (8.9%) in the pentoxifylline group and 61/571 (10.7%) in the control group. Pentoxifylline was not significantly associated with increase or decrease in the risk of CIN (RR 0.84 [0.59, 1.19], p=0.32; I2: 0%, p=0.89). Subgroup analysis for elective studies showed a non-significant result (RR 0.77 [0.47, 1.27], p=0.31; I2: 0%). Meta-regression analysis showed that the association between pentoxifylline and mortality was not affected by age (p=0.994), gender (reference: male, p=0.562), hypertension (p=0.336), diabetes (p=0.536), baseline serum creatinine (p=0.344), contrast used (p=0.431), and CIN incidence (p=0.521). GRADE Approach showed a low certainty of evidence for the effect estimate of pentoxifylline on CIN. CONCLUSIONS: Our meta-analysis showed that pentoxifylline was not associated with the risk of CIN with low certainty of evidence. Hence, larger, multicentre, double-blind randomized controlled trials are required.

Diagnostic prediction model in subjects with low-risk unstable angina pectoris/non-ST segment Elevation Myocardial Infarction.

OBJECTIVE: This study aims to construct a prediction model based on non-invasive examination and cardiovascular risk factors, to predict the presence of coronary artery disease (CAD) and its severity in patients with low-risk unstable angina pectoris (UAP)/Non-ST Segment Elevation Myocardial Infarction (NSTEMI). PATIENTS AND METHODS: This cross-sectional study aimed to assess the association between non-invasive examinations and cardiovascular risk factors in predicting CAD. Model constructed based on non-invasive assessment and cardiovascular risk factors was compared to coronary angiography, the reference standard. RESULTS: This study included 104 patients, comprising 60 men and 44 women, who fulfilled the inclusion criteria. The mean age was 52.3 (6.8) years. Two diagnostic prediction models were constructed after series of analyses. The main model consists of NO, CIMT, history of smoking, and Age-Gender, while the alternative model consists of CIMT, history of smoking, and Age-Gender. The main model has AUC of 74.5% (95% CI: 64.9-84.1), sensitivity of 72.7% (95% CI: 57.2-85.0), specificity 65.0% (95% CI: 51.6 -76.9 for a cut-off point of 74.5. While the alternative model has 69.0% AUC (95% CI: 58.9-79.1), sensitivity of 65.9% (95%: 50.1-79, 5), a specificity of 56.7% (95% CI: 43.2-69.4) for a cut-off point of 69. The main model and the alternative model have similar diagnostic prediction performance based on the ROC comparison test (p = 0.70). CONCLUSIONS: Based on these results, we conclude that NO, CIMT, smoking history, and age-gender have a value of diagnostic validity in subjects with low-risk UAP/NSTEMI.

The obesity paradox: effect of body mass index on 2-years clinical outcome after primary percutaneous coronary intervention in Indonesia.

OBJECTIVE: Several studies demonstrated that a high body mass index (BMI) might actually benefit patients with cardiovascular disease, including coronary heart disease. However, other studies were unable to confirm this paradoxical phenomenon in all populations. Therefore, this study aims to determine the association between BMI and long-term clinical outcomes in ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI). PATIENTS AND METHODS: This was a retrospective cohort study of 400 STEMI patients undergoing PCI. Clinical outcome evaluation was done by face-to-face or phone interview and collecting objective data. Statistical analysis was performed to compare the outcomes between underweight-normal group with overweight-obese group. RESULTS: The incidence of major adverse cardiovascular events (MACE) was lower in patients with higher BMI group in 2-years evaluation (24.1% vs. 39.9%; p < 0.001). Multivariate analysis showed that BMI was an independent predictor of MACE and the incidence of recurrent infarction (OR 2.322 [CI 95% 1.505-3.584; p < 0.001]). The risk of MACE reduces as the weight increases, with a nadir of risk reduction for MACE at 28 to 29.0 kg/m2, in which the curve rises after, but remained below the risk associated with BMI of 23 kg/m2. CONCLUSIONS: In our population, patients with high BMI have a lower incidence of long-term MACE, especially recurrent myocardial infarction, in patients with STEMI undergoing PCI.

The association between serum prealbumin and poor outcome in COVID-19 - Systematic review and meta-analysis.

OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the association between the prealbumin and severity and mortality in COVID-19. MATERIALS AND METHODS: We performed a systematic literature search from PubMed, Embase, and Scopus databases up until 2 February 2021. The primary outcome was the poor outcome, a composite of mortality and severity. Severe COVID-19 was defined as COVID-19 that fulfill the criteria for severe pneumonia or patients with acute respiratory distress syndrome/disease progression/need for intensive care unit or mechanical ventilation. The effect estimates were a mean difference between patients with and without a poor outcome in mg/dL and odds ratio (OR) per 1 mg/dL decrease in prealbumin level. The effect estimates were reported with their 95% confidence interval (95% CI). RESULTS: Nine studies comprising of 2104 patients were included in this systematic review and meta-analysis. Patients with poor outcome have lower prealbumin level (mean difference -71.48 mg/dL [95% CI -93.74, -49.22], p<0.001; I2: 85.9%). Every 1 mg/dL decrease in prealbumin level was associated with 1% increase in poor outcome (OR 0.992 [0.987, 0.997], p=0.004, I2: 81.7%). Meta-regression analysis showed that the association between the prealbumin level and poor outcome varies with gender (male) (coefficient: 3.50, R2: 100%, p<0.001), but not age, diabetes, hypertension, and chronic kidney disease. CONCLUSIONS: Low serum prealbumin was associated with poor outcomes in patients with COVID-19.

The effect of trimetazidine on contrast-induced nephropathy in patients undergoing coronary angiography and/or percutaneous coronary intervention - A systematic review and meta-analysis.

OBJECTIVE: In this study, we aimed to evaluate whether the trimetazidine administration before CAG and/or PCI reduces the incidence of contrast-induced nephropathy (CIN). We also aimed to evaluate the factors affecting the effect and the certainty of the evidence. MATERIALS AND METHODS: A systematic literature search was performed to obtain studies that assess trimetazidine's effect on the incidence of CIN in CAG/PCI patients up until 21 January 2021 through PubMed, Embase, and Scopus. The main outcome is CIN, defined as the increase in serum creatinine level ≥ 0.5 mg/dL (44.2 mmol/L) or > 25% of the baseline value 48-72 h after contrast media (CM) administration. RESULTS: This systematic review and meta-analysis includes seven studies involving a total of 1590 patients. The prevalence of CIN was 11% [8%, 14%]. CIN's prevalence was 6% [4%, 8%] in the trimetazidine group and 16% [12%, 20%] in the control group. Trimetazidine use is associated with a lower incidence of CIN (RR 0.46 [0.34, 0.63], p<0.001; I2: 0%) with a high certainty of evidence, with an absolute risk reduction of 78 fewer per 1000. Subgroup analysis in patients with renal insufficiency showed that trimetazidine lowers the risk of CIN (RR 0.40 [0.26, 0.61], p<0.001; I2: 0%). The CIN reducing effect of trimetazidine was not significantly influenced by the age (p=0.960), body mass index (p=0.816), hypertension (p=0.595), diabetes (p=0.362), ejection fraction (p=0.261), baseline serum creatinine (0.579), and contrast media volume (p=0.958). CONCLUSIONS: Trimetazidine administration decreases the risk of CIN in patients undergoing CAG/PCI.

Body mass index and outcome in patients with COVID-19: A dose-response meta-analysis.

BACKGROUND: There is mounting evidence related to the association between obesity and severity of COVID-19. However, the direct relationship of the increase in the severe COVID-19 risk factors, with an increase in body mass index (BMI), has not yet been evaluated. AIM: This meta-analysis aims to evaluate the dose-response relationship between body mass index (BMI) and poor outcome in patients with COVID-19. METHODS: A systematic literature search was conducted using PubMed, Europe PMC, ProQuest, and the Cochrane Central Database. The primary outcome was composite poor outcome composed of mortality and severity. The secondary outcomes were mortality and severity. RESULTS: A total of 34,390 patients from 12 studies were included in this meta-analysis. The meta-analysis demonstrated that obesity was associated with composite poor outcome (OR 1.73 [1.40, 2.14], P<0.001; I2: 55.6%), mortality (OR 1.55 [1.16, 2.06], P=0.003; I2: 74.4%), and severity (OR 1.90 [1.45, 2.48], P<0.001; I2: 5.2%) in patients with COVID-19. A pooled analysis of highest BMI versus reference BMI indicate that a higher BMI in the patients was associated with composite poor outcome (aOR 3.02 [1.82, 5.00], P<0.001; I2: 59.8%), mortality (aOR 2.85 [1.17, 6.92], P=0.002; I2: 79.7%), and severity (aOR 3.08 [1.78, 5.33], P<0.001; I2: 11.7%). The dose-response meta-analysis showed an increased risk of composite poor outcome by aOR of 1.052 [1.028, 1.077], P<0.001 for every 5kg/m2 increase in BMI (Pnon-linearity<0.001). The curve became steeper with increasing BMI. CONCLUSION: Dose-response meta-analysis demonstrated that increased BMI was associated with increased poor outcome in patients with COVID-19.

Effect of chronic obstructive pulmonary disease and smoking on the outcome of COVID-19.

OBJECTIVE: To investigate the association between chronic obstructive pulmonary disease (COPD) and smoking with outcome in patients with COVID-19.METHODS: A systematic literature search was performed using PubMed, EuropePMC, SCOPUS and the Cochrane Central Database. A composite of poor outcome, mortality, severe COVID-19, the need for treatment in an intensive care unit (ICU) and disease progression were the outcomes of interest.RESULTS: Data on 4603 patients were pooled from 21 studies. COPD was associated with an increased risk for composite poor outcome (OR 5.01, 95%CI 3.06-8.22; P < 0.001; I² 0%), mortality (OR 4.36, 95%CI 1.45-13.10; P = 0.009; I² 0%), severe COVID-19 (OR 4.62, 95%CI 2.49-8.56; P < 0.001; I² 0%), ICU care (OR 8.33, 95%CI 1.27-54.56; P = 0.03; I² 0%), and disease progression (OR 8.42, 95%CI 1.60-44.27; P = 0.01; I² 0%). Smoking was found to increase the risk of composite poor outcome (OR 1.52, 95%CI 1.16-2.00; P = 0.005; I² 12%), and subgroup analysis showed that smoking was significant for increased risk of severe COVID-19 (OR 1.65, 95%CI 1.17-2.34; P = 0.004; I² 11%). Current smokers were at higher risk of composite poor outcomes (OR 1.58, 95%CI 1.10-2.27; P = 0.01; I² 0%) than former/non-smokers.CONCLUSION: Our systematic review and meta-analysis revealed that COPD and smoking were associated with poor outcomes in patients with COVID-19.