Conventional endotracheal tubes versus polymer-coated tubes in ventilator-associated pneumonia development: A systematic review and meta-analysis.

Introduction: Endotracheal tubes (ETT) are used in patients who require ventilatory support. Colonization of ETTs by microorganisms is associated with developing ventilator-associated pneumonia (VAP). Thus, this meta-analysis aims to compare conventional endotracheal tubes with those made using materials designed to prevent colonization. Methods: This analysis was conducted according to the PRISMA guidelines. During May 2024, we searched multiple databases (PubMed, Cochrane and Embase) for randomized controlled trials (RCT) comparing the incidence of ventilator-associated pneumonia between conventional and coated tubes. Studies with patients with less than 48 h of intubation were excluded. Our primary endpoint was the incidence of VAP in patients intubated with either conventional or coated endotracheal tubes. Statistical analysis was performed using Review Manager Software, and a The Mantel-Haenszel test was performed using a random effects model, and risk ratios (RR) were calculated for binary outcomes. Subgroup analyses were conducted using a fixed effects model when heterogeneity was low. Risk assessment was carried out using the Risk of Bias 2 tool. Results: Our search identified 6 RCTs eligible in our inclusion criteria, enrolling 2680 patients, with 1361 (50,78 %) undergoing intubation using a polymer-coated tube. The statistical data indicated that coated endotracheal tubes perform better in preventing pneumonia than conventional tubes (RR 0.57 Cl 95 % 0.45-0.90; p < 0.001; I2 0 %). Additionally, conventional tubes were also associated with higher bacterial colonization (47.02 CI 95 % 26.88-68.18; p < 0.01; I2 81 %) compared to coated tubes. Conclusions: These findings indicate that utilizing a silver-coated endotracheal tube for intubation is more efficacious than conventional tubes, presenting it as a strategy to combat ventilator-associated pneumonia.

Comparing pulsed field ablation with very high-power and high-power short-duration radiofrequency ablation for atrial fibrillation: a systematic review and meta-analysis.

BACKGROUND: Catheter ablation is a key treatment for atrial fibrillation (AF), with high-power, very high-power short-duration and pulsed field ablation (PFA) being efficient options. However, direct comparisons between these techniques are lacking. OBJECTIVE: We performed a systematic review and meta-analysis, which included predominantly observational studies (four retrospective and one prospective study), to compare PFA and High-power short-duration (HPSD) and very high-power short-duration (vHPSD) radiofrequency (RF) ablation in patients with AF. METHODS: We searched PubMed, Embase and Cochrane Central. Outcomes of interest included: Arrhythmia-free survival (AF, atrial flutter, and atrial tachycardia recurrences 30 s during follow-up after a 1-month blanking period), procedure time, fluoroscopy time, fluoroscopy dose, complications overall. Statistical analysis was performed using the R program (version 4.3.2). Heterogeneity was assessed with I2 statistics. RESULTS: Our meta-analysis included 1,255 patients from 5 studies, with a mean age ranging from 63 to 68 years. Among them, 554 (45.2%) underwent pulsed field ablation (PFA) and 701 (55.8%) received high/very high potential short-duration ablation. PFA improved arrhythmia-free survival (RR 1.05; 95% CI 1.002-1.120; P = 0.004; I2 = 0%) and reduced procedure time (MD -29.95 min; 95% CI -30.90 to -29.00; P < 0.01; I2 = 0%). However, PFA increased fluoroscopy time (MD 6.33 min; 95% CI 1.65 to 11.01; P < 0.01; I2 = 98%) and showed no significant difference in overall complications (RR 0.88; 95% CI 0.38-2.02; P = 0.756; I2 = 47%), cardiac tamponade (RR 1.62; 95% CI 0.27-9.85; P = 0.599; I2 = 40%), or stroke/transient ischemic attack (TIA) incidence (RR 0.64; 95% CI 0.15-2.80; P = 0.555; I2 = 0%). PFA was associated with a reduced need for redo procedures (RR 0.66; 95% CI 0.45-0.97; P = 0.036; I2 = 0%) and did not significantly affect the fluoroscopy dose (MD 896.86 mGy·cm2; 95% CI -1269.44 to 3063.15; P = 0.42; I2 = 39%). CONCLUSION: In this meta-analysis, PFA was associated with improved arrhythmia-free survival and reduced procedure time, although it resulted in increased fluoroscopy time. PFA and high/very high power short-duration ablation yielded similar outcomes regarding overall complications, cardiac tamponade, and stroke/TIA incidence. Both techniques demonstrated comparable efficacy in treating atrial fibrillation.

Avaliação prognóstica de níveis glicêmicos em pacientes com choque cardiogênico: uma revisão sistemática e metanálise / Prognostic assessment of glycemic levels in patients with cardiogenic shock: a systematic review and meta-analysis

INTRODUÇÃO: Embora a hiperglicemia tenha valor prognóstico nas doenças cardiovasculares, há poucos dados disponíveis sobre seu valor prognóstico para pacientes em choque cardiogênico. OBJETIVO: Conduzir uma revisão sistemática e metanálise para avaliar os níveis glicêmicos no momento da admissão hospitalar em pacientes com choque cardiogênico decorrente de diversas causas etiológicas. MÉTODOS: Realizamos uma revisão sistemática nas bases de dados Elsevier, PubMed e Cochrane de estudos que avaliassem o valor prognóstico de índices glicêmicos na admissão de pacientes com choque cardiogênico, sendo o desfecho primário mortalidade geral. Incluímos estudos que definiram como hiperglicemia valores de corte de 180 a 220 mg/dL. Para a análise estatística foi utilizado o RevMan 5.1.7, e a heterogeneidade foi avaliada usando estatísticas I². RESULTADOS: Um total de 7 dos 5.214 estudos foram incluídos, resultando 3.504 pacientes, com média de idade variando entre 60 e 74 anos, sendo 2.242 (64%) homens. Desses pacientes, cerca de 926 (26%) tinham o diagnóstico prévio de Diabetes Mellitus. Estes pacientes foram divididos em subgrupos conforme seu índice glicêmico na admissão, Normoglicemia (<180mg/dL) e Hiperglicemia (180-220 mg/dL). O grupo hiperglicêmico foi associado a maior mortalidade (OR 2,14; IC 95% 1,53 - 3,00; p<0.00001; I²= 53%; Figura 1). CONCLUSÃO: Nesta revisão sistemática e metanálise, valores de glicemia entre 180 a 220 mg/dL foram associados a maior risco de mortalidade em pacientes em choque cardiogênico.

Revascularização completa versus parcial para idosos com síndrome coronariana aguda: uma metanálise e revisão sistemática de dados randomizados e ajustados multivariáveis / Complete versus partial revascularization for elderly people with acute coronary syndrome: a meta-analysis and systematic review of randomized, multivariable-adjusted data

Introdução: Evidências de estudos randomizados apoiam a revascularização completa em vez do culpado apenas para pacientes com síndrome arterial coronariana aguda (SCA) e doenças coronarianas multiarteriais. Se estes resultados se estendem a pacientes idosos, no entanto, não foi completamente explorado. Métodos: Realizamos uma revisão sistemática e meta-análise comparando os resultados clínicos de idosos (definidos como idade >;75 anos) com SCA e DMV submetidos à intervenção coronária percutânea (ICP) completa vs. parcial. Foram pesquisados ​​PubMed, Embase e Cochrane. Calculamos razões de risco agrupadas com intervalos de confiança (IC) de 95% para preservar os dados de tempo até o evento. Resultados: Incluímos 7 estudos, dos quais 2 eram RCT e 5 eram coortes ajustadas multivariáveis, compreendendo um total de 10 147, dos quais 43,8% foram submetidos à revascularização completa. Em comparação com PCI apenas parcial, a revascularização completa foi associada a uma menor mortalidade por todas as causas (razão de risco 0,71; IC 95% 0,60-0,85; P < 0,01), mortalidade cardiovascular (razão de risco 0,64; IC 95% 0,52-0,79; P < 0,01) e infarto do miocárdio recorrente (razão de risco 0,65; IC 95% 0,50-0,85; P < 0,01). Não houve diferença significativa entre os grupos em relação ao risco de revascularizações (razão de risco 0,80; IC 95% 0,53-1,20; P = 0,28). Conclusão: Entre pacientes idosos com SCA e DAC multiarterial, a revascularização completa está associada a um menor risco de mortalidade por todas as causas, mortalidade cardiovascular e infarto do miocárdio recorrente.

The cardiotoxic effects of CAR-T cell therapy: An updated systematic review and meta-analysis.

BACKGROUND: Chimeric antigen receptor T-cell (CAR-T) therapy has shown promise in treating hematologic malignancies, yet its potential cardiotoxic effects require thorough investigation. OBJECTIVES: We aim to conduct a systematic review and meta-analysis to examine the cardiotoxic effects of CAR-T therapy in adults with hematologic malignancies. METHODS: We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials for studies reporting cardiovascular outcomes, such as arrhythmias, heart failure, and reduced left ventricle ejection fraction (LVEF). RESULTS: Our analysis of 20 studies involving 4789 patients revealed a 19.68% incidence rate of cardiovascular events, with arrhythmias (7.70%), heart failure (5.73%), and reduced LVEF (3.86%) being the most prevalent. Troponin elevation was observed in 23.61% of patients, while NT-Pro-BNP elevation was observed in 9.4. Subgroup analysis showed higher risks in patients with pre-existing conditions, such as atrial arrhythmia (OR 3.12; p < .001), hypertension (OR 1.85; p = .002), previous heart failure (OR 3.38; p = .003), and coronary artery disease (OR 2.80; p = .003). CONCLUSION: Vigilant cardiovascular monitoring is crucial for patients undergoing CAR-T therapy to enhance safety and treatment efficacy.Novelty Statements.

The cardiotoxic effects of CAR-T cell therapy: an updated systematic review and meta-analysis

BACKGROUND: Chimeric antigen receptor T-cell (CAR-T) therapy has shown promise in treating hematologic malignancies, yet its potential cardiotoxic effects require thorough investigation. OBJECTIVES: We aim to conduct a systematic review and meta-analysis to examine the cardiotoxic effects of CAR-T therapy in adults with hematologic malignancies. METHODS: We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials for studies reporting cardiovascular outcomes, such as arrhythmias, heart failure, and reduced left ventricle ejection fraction (LVEF). RESULTS: Our analysis of 20 studies involving 4789 patients revealed a 19.68% incidence rate of cardiovascular events, with arrhythmias (7.70%), heart failure (5.73%), and reduced LVEF (3.86%) being the most prevalent. Troponin elevation was observed in 23.61% of patients, while NT-Pro-BNP elevation was observed in 9.4. Subgroup analysis showed higher risks in patients with pre-existing conditions, such as atrial arrhythmia (OR 3.12; p < .001), hypertension (OR 1.85; p = .002), previous heart failure (OR 3.38; p = .003), and coronary artery disease (OR 2.80; p = .003). CONCLUSION: Vigilant cardiovascular monitoring is crucial for patients undergoing CAR-T therapy to enhance safety and treatment efficacy.Novelty Statements.

Complete versus partial revascularization for older adults with acute coronary syndrome: a meta-analysis and systematic review of randomized and multivariable adjusted data

BACKGROUND Evidence from randomized studies support complete over culprit-only revascularization for patients with acute coronary artery syndrome (ACS) and multivessel coronary artery diseases (MVD). Whether these findings extend to elderly patients, however, has not been thoroughly explored. METHODS We conducted a systematic review and meta-analysis comparing clinical outcomes of elderly individuals (defined as age ≥75 years) with ACS and MVD submitted to complete vs partial-only percutaneous coronary intervention (PCI). PubMed, Embase, and Cochrane were searched. We computed pooled hazard ratios with 95% confidence intervals (CI) to preserve time time-to-event data. RESULTS We included 7 studies, of which 2 were RCT and 5 were multivariable adjusted cohorts, comprising a total 10 147, of whom 43.8% underwent complete revascularization. As compared with partial-only PCI, complete revascularization was associated with a lower all-cause mortality (hazard ratio 0.71; 95% CI 0.60­0.85; P < 0.01), cardiovascular mortality (hazard ratio 0.64; 95% CI 0.52­0.79; P < 0.01), and recurrent myocardial infarction (hazard ratio 0.65; 95% CI 0.50­0.85; P < 0.01). There was no significant difference between groups regarding the risk of revascularizations (hazard ratio 0.80; 95% CI 0.53­1.20; P = 0.28). CONCLUSION Among elderly patients with ACS and multivessel CAD, complete revascularization is associated with a lower risk of all-cause mortality, cardiovascular mortality, and recurrent myocardial infarction.