Background and Aims
Current clinical guidelines for treating left ventricular thrombus (LVT) are limited by inadequate evidence to inform the comparative efficacy of oral anticoagulants. In this ...meta‐analysis, we aimed to compare the efficacy and safety of direct oral anticoagulants (DOAC) to vitamin K antagonists (VKA) in patients with LVT.
Methods
Four standard databases were searched for relevant literature comparing the efficacy and safety between DOAC and VKA for LVT treatment, published before August 19, 2023. Both the randomized controlled trials and observational studies were included in the analysis. The outcomes of interest were the resolution of LVT, all‐cause mortality, stroke, systemic embolism, and bleeding. Data from the selected studies were extracted and analyzed using RevMan 5.4 using odds ratio.
Results
Among 3959 studies from the database search and bibliography review, 33 were included in the analysis. LVT resolution was observed in 72.59% in the DOAC group versus 67.49% in the VKA group (odds ratio OR: 1.28, confidence interval CI: 1.07–1.53). Mortality was lower in the DOAC group (11.71% vs. 18.56%) (OR: 0.60, CI: 0.36–1.00; borderline statistical significance). Likewise, bleeding events (9.60% vs. 13.19%) (OR: 0.65, CI: 0.52–0.81) and stroke (7.54% vs. 11.04%) (OR: 0.71, CI: 0.53–0.96) were also significantly lower in the DOAC group.
Conclusion
DOAC use for LVT showed better thrombus resolution and reduced risk of bleeding and stroke compared to VKA. Likewise, DOAC use was associated with lower mortality with borderline statistical significance.
Iron deficiency with or without anemia is a common comorbidity co-existing with heart failure patients and is an independent risk factor for heart failure exacerbation and worse prognosis. A growing ...number of randomized clinical trials and meta-analysis evaluated the clinical efficacy and safety of intravenous iron use in heart failure patients. However, the findings from them are inconsistent and often conflicting.
This meta-analysis was performed based on PRISMA (Preferred Reporting Items or Systematic Reviews and Meta-Analyses) guidelines after registering in PROSPERO (CRD42023395888). A literature search was conducted using a systematic search of PubMed, Embase, and Scopus databases until September 30, 2023. Pertinent data from the included studies were extracted and analyzed using RevMan v5.4.
Out of 4585 studies evaluated, 16 randomized control trials with 6739 acute or chronic heart failure patients were included for analysis. The intravenous iron therapy significantly lowered the composite HF hospitalization or cardiovascular death (OR 0.56; 95% CI 0.40 to 0.79; I2 = 83%, P = 0.001), HF hospitalization (OR 0.69, 95% CI 0.54 to 0.90; I2=57%, P=0.005), improved 6-minute walk test (MD: 20.02 (95% CI 8.16 to 31.87; I2=40%, P=0.0009), and the change in mean LVEF (MD: 2.03, 95% CI 0.49-3.58; P=0.010). The risks of total and serious adverse events were not significantly increased with the Iron therapy compared to the placebo/standard of care group.
Based on this meta-analysis, the intravenous iron intervention among heart failure patients with iron deficiency significantly reduced the risk of hospitalization from heart failure exacerbation. In addition, there was improved exercise performance and left ventricular function from baseline with no significant increased risk of serious adverse events.
IMPORTANCE: Although outcomes in patients with ST-segment elevation myocardial infarction (STEMI) have improved in the past 2 decades, a sex disparity exists in survival, with women having higher ...mortality than men. OBJECTIVE: To conduct a meta-analysis of observational studies that examined differences in mortality by sex in patients with STEMI treated with primary percutaneous coronary intervention (PPCI). DATA SOURCES: MEDLINE, EMBASE, Cochrane central, and electronic databases were searched for relevant studies in all languages and without time restriction. STUDY SELECTION: Studies were included if (1) they studied patients who presented with STEMI, (2) primary percutaneous coronary intervention (PPCI) was the treatment for STEMI, (3) PPCI was performed within 12 hours of symptom onset, and (4) sex-specific in-hospital and/or 1-year mortality were reported. DATA EXTRACTION AND SYNTHESIS: Two investigators independently reviewed retrieved citations and assessed eligibility. Discrepancies were resolved by consensus. Quality of included studies was assessed using Newcastle-Ottawa Quality Assessment Scale for cohort studies. Data were pooled using a random-effects model. MAIN OUTCOMES AND MEASURES: Sex-specific in-hospital and 1-year all-cause mortality. Risk ratios (RRs) of mortality were used for these 2 time points, if reported. RESULTS: Of the 149 studies identified, 35 met inclusion criteria, representing 18 555 women and 49 981 men. In the unadjusted analyses, women were at a higher risk for in-hospital (RR, 1.93; 95% CI, 1.75-2.14 P < .001, I2 = 14%) and 1-year all-cause mortality (RR, 1.58; 95% CI, 1.36-1.84 P < .001, I2 = 51%) compared with men. However, when adjusted RRs were used, the association between women and higher risk of all-cause mortality was attenuated but still significantly elevated for in-hospital mortality (RR, 1.48; 95% CI, 1.07-2.05 P = .02, I2 = 56%), but the higher risk for 1-year mortality in women was no longer significant (RR, 0.90; 95% CI, 0.69-1.17 P = .42, I2 = 58%). CONCLUSIONS AND RELEVANCE: An increased mortality in women with STEMI treated with PPCI was detected in this large meta-analysis but is likely confounded by baseline cardiovascular risk factors and the differences in clinical profile of male and female patients with STEMI. Intensive cardiovascular risk modification efforts in women may help to reduce this sex disparity.
Background: Outcome data following transcatheter mitral valve repair (TMVR) with the MITRACLIP® device are scarce outside the pivotal randomized controlled trials.
Methods: The Nationwide Readmission ...Data base (NRD) was utilized for years 2013–2017 to identify the study population. Thirty-day readmission pattern, in-hospital complications, causes of readmissions, and multivariate predictors for readmission, complications and mortality were explored.
Results: We noted a total of 14,647 index admissions related to MITRACLIP of which 48% of procedures were performed at high volume centers (Annual hospital volume ≥ 25). A total of 15% of patients were readmitted within 30 days of discharge most frequently due to cardiac causes. Approximately 33% of patients were discharged within 24 h of the procedure. The in-hospital mortality rate was 2.8% and in-hospital complication rate was 14.6%. The most common complications were cardiac complications (8.2%), bleeding related complications (5.9%) and vascular complications (0.65%). On multivariate modeling, female sex, CHF, Atrial fibrillation, prior PCI, COPD, CKD, transfer to skilled nursing facility, length of stay ≥2 days were associated with a high risk of readmission. Additionally, coagulopathy, chronic kidney disease and lengthier hospital stays were associated with high risk of complication or death.
Conclusion: The 30-day readmission rate following commercial treatment with the MITRACLIP device is 15%. Half of these admission were from a cardiac etiology. Heart failure, atrial arrhythmias and clip related complications round out the top 3 cardiac reasons for readmission. There was no impact of hospital size, teaching status or case volume on mortality and in hospital complication rates.
•50% of Mitraclips were implanted at high volume centers, no association between hospital volume and outcomes were noted•Cardiac etiologies account for half of the readmissions within 30 days of discharge after Mitraclip procedure•About 1/3rd of the patients are discharged same day after Mitraclip procedure•Female gender, CHF, Atrial fibrillation, prior PCI, COPDand CKD were associated with high risk of 30-day readmission.
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