Abstract 12188: Intensive Glycemic Control in Patients With Acute Coronary Syndrome: Evidence From a Meta-Analysis

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Partha Sardar ◽  
Ramez Nairooz ◽  
Saurav Chatterjee ◽  
Jacob A Udell ◽  
Dharam J Kumbhani ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Glycemic Control ◽  
Meta Analysis ◽  
Random Effect ◽  
Intensive Glucose Control ◽  
Intensive Glycemic Control ◽  
Coronary Syndrome ◽  
All Cause Mortality ◽  
Glucose Management ◽  
Management Groups

Introduction: Hyperglycemia is associated with unfavorable prognosis in patients with acute coronary syndrome (ACS). Studies with intensive glycemic control in ACS patients have provided inconsistent results. A meta-analysis was performed to evaluate the effectiveness and safety of intensive glycemic control in patients with ACS. Methods: Search of PubMed, Cochrane CENTRAL, EMBASE, EBSCO, Web of Science and CINAHL databases from their inception through April 2014, identifying randomized controlled trials (RCTs) comparing the effects of intensive versus standard glucose management in patients with ACS. We calculated summary random-effect odds ratios (OR) and 95% confidence intervals (CI). Results: Results from 10 RCTs comprising 2,621 patients were analyzed. All-cause mortality between intensive versus standard glucose management groups did not differ significantly (OR 1.00, 95% CI 0.75-1.34). Similarly, no significant differences were observed between the comparator groups for the odds of cardiac mortality (OR 0.87, 95% CI, 0.67 to 1.12), recurrent myocardial infarction (OR 1.07, 95% CI, 0.76 to 1.52), or stroke (OR 1.20, 95% CI, 0.60 to 2.40). The risk of hypoglycemia (OR 5.95, 95% CI, 2.73 to 12.97; p<0.001) was significantly higher with intensive compared with standard glucose management. Conclusions: Intensive glucose control compared with standard care in ACS patients did not reduce mortality or morbidity, but significantly increased the risk of hypoglycemia. These data from prior clinical trials should be interpreted in the context of their significant methodological limitations.

Abstract 309: Is Right Bundle Branch Block Associated with Poor Outcomes in the Setting of an Acute Coronary Syndrome? A Systematic Review and Meta-analysis

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Ahmad Hazem ◽  
Sunita Sharma ◽  
Amit Sharma ◽  
Cameron Leitch ◽  
Roopalakshmi Sharadanant ◽  
...  
Keyword(s):  
Systematic Review ◽  
Acute Coronary Syndrome ◽  
Right Bundle Branch Block ◽  
Risk Ratio ◽  
Meta Analysis ◽  
Forest Plot ◽  
Bundle Branch Block ◽  
Coronary Syndrome ◽  
All Cause Mortality

Importance: Up to 10% of patients with acute myocardial infarction (AMI) have right bundle branch block (RBBB), and RBBB has been associated with a higher risk of mortality. We performed a systematic review and meta-analysis to determine the prognostic significance of RBBB for patients with AMI. Acute coronary syndrome (ACS) Data Sources: We have systematically searched Ovid, Scopus and Web of Science through January 2014. Study Selection: Reviewers working independently and in duplicate screened all eligible abstracts, selecting studies that described all-cause mortality or cardiovascular death in patients with RBBB and suspected ACS. We excluded studies that reported unadjusted outcomes. Knowledge synthesis: We pooled risk ratio with hazard ratio in studies reporting those outcomes. When reported, odds ratio was converted into risk ratio using reported event rate in each study’s unexposed -read: non RBBB- group. Main Outcomes: All-cause mortality and cardiovascular mortality (death). Results: Eighteen studies were found that reported eligible data. All were observational studies, involving over 89,000 patients. In short-term follow up (up to 30 days), RBBB on presentation was associated with higher all-cause mortality rate, compared to patients without RBBB (RR 2.23, 95% CI 1.76-2.82). There was a trend for higher mortality at long-term follow up (range: 6 months-16 years) that did not reach statistical significance (RR 1.45, 95% CI 0.93-2.25). Figure-1 demonstrates the forest plot. Risk of bias was assessed with the Newcastle-Ottawa scale and majority of included studied were deemed moderate to high quality. Conclusion and Relevance: RBBB is associated with a more than 2-fold higher risk of all-cause mortality in patients with AMI at 30 days follow up. Patients with AMI and RBBB represent a high risk group for adverse outcomes. A sentence on the differential findings for new vs. old RBBB and association with outcomes could follow here.

scholarly journals Serum albumin level for prediction of all-cause mortality in acute coronary syndrome patients: a meta-analysis

2020 ◽  
Vol 40 (1) ◽  
Author(s):  
Lingjun Zhu ◽  
Miaomiao Chen ◽  
Xiaoping Lin
Keyword(s):  
Acute Coronary Syndrome ◽  
Serum Albumin ◽  
Mortality Risk ◽  
Serum Albumin Level ◽  
Meta Analysis ◽  
Albumin Level ◽  
Coronary Syndrome ◽  
All Cause Mortality ◽  
The Impact ◽  
Low Serum

Abstract The prognostic utility of serum albumin level as a predictor of survival in patients with acute coronary syndrome (ACS) has attracted considerable attention. This meta-analysis sought to investigate the prognostic value of serum albumin level for predicting all-cause mortality in ACS patients. A systematic literature search was conducted in Pubmed and Embase databases until 5 March 2019. Epidemiological studies investigating the association between serum albumin level and all-cause mortality risk in ACS patients were included. Eight studies comprising 21667 ACS patients were included. Meta-analysis indicated that ACS patients with low serum albumin level had an increased risk of all-cause mortality (risk ratio [RR] 2.15; 95% confidence interval [CI] 1.68–2.75) after adjusting for important covariates. Subgroup analysis showed that the impact of low serum albumin level was stronger in hospital mortality (RR 3.09; 95% CI 1.70–5.61) than long-term all-cause mortality (RR 1.75; 95% CI 1.54–1.98). This meta-analysis demonstrates that low serum albumin level is a powerful predictor of all-cause mortality in ACS patients, even after adjusting usual confounding factors. However, there is lack of clinical trials to demonstrate that correcting serum albumin level by means of intravenous infusion reduces the excess risk of death in ACS patients.

scholarly journals EFFECTS OF AN INTENSIVE GLYCEMIC CONTROL WITH INSULIN ON PLATELET REACTIVITY IN PATIENTS WITH ACUTE CORONARY SYNDROME: A LONG-TERM RESULTS OF THE CHIPS STUDY

2012 ◽  
Vol 59 (13) ◽  
pp. E529
Author(s):  
David Vivas ◽  
Esther Bernardo ◽  
Juan Carlos Garc&iacute;a-Rubira ◽  
Dominick Angiolillo ◽  
Patricia Mart&iacute;n ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Glycemic Control ◽  
Platelet Reactivity ◽  
Long Term Results ◽  
Intensive Glycemic Control ◽  
Coronary Syndrome

Association Between Metabolic Syndrome and All-Cause Mortality in Patients with Acute Coronary Syndrome: A Meta-Analysis

2021 ◽  
Author(s):  
Yong Yang ◽  
Haili Shen ◽  
Zhigeng Jin ◽  
Dongxing Ma ◽  
Qing Zhao ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Meta Analysis ◽  
Survival Outcome ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
All Cause Mortality

AbstractThe association between metabolic syndrome (MetS) and survival outcome after acute coronary syndrome (ACS) remains controversial. This meta-analysis sought to examine the association of MetS with all-cause mortality among patients with ACS. Two authors independently searched PubMed and Embase databases (from their inception to June 27, 2020) for studies that examined the association of MetS with all-cause mortality among patients with ACS. Outcome measures were in-hospital mortality and all-cause mortality during the follow-up. A total of 10 studies involving 49 896 ACS patients were identified. Meta-analysis indicated that presence of MetS was associated with an increased risk of long-term all-cause mortality [risk ratio (RR) 1.25; 95% CI 1.15–1.36; n=9 studies] and in-hospital mortality (RR 2.35; 95% CI 1.40–3.95; n=2 studies), respectively. Sensitivity and subgroup analysis demonstrated the credibility of the value of MetS in predicting long-term all-cause mortality. MetS is associated with an increased risk of long-term all-cause mortality among patients with ACS. However, additional studies are required to investigate the association of MetS with in-hospital mortality.

scholarly journals Comparison of Safety and Efficacy Between Clopidogrel and Ticagrelor in Elderly Patients With Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Xiangkai Zhao ◽  
Jian Zhang ◽  
Jialin Guo ◽  
Jinxin Wang ◽  
Yuhui Pan ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Elderly Patients ◽  
Meta Analysis ◽  
Adenosine Diphosphate ◽  
Cardiovascular Death ◽  
Minor Bleeding ◽  
Efficacy And Safety ◽  
Coronary Syndrome ◽  
All Cause Mortality ◽  
Receptor Inhibitor

Background: Dual antiplatelet therapy combining aspirin with a P2Y12 adenosine diphosphate receptor inhibitor is a therapeutic mainstay for acute coronary syndrome (ACS). However, the optimal choice of P2Y12 adenosine diphosphate receptor inhibitor in elderly (aged ≥65 years) patients remains controversial. We conducted a meta-analysis to compare the efficacy and safety of ticagrelor and clopidogrel in elderly patients with ACS. Methods: We comprehensively searched in Web of Science, EMBASE, PubMed, and Cochrane databases through 29th March, 2021 for eligible randomized controlled trials (RCTs) comparing the efficacy and safety of ticagrelor or clopidogrel plus aspirin in elderly patients with ACS. Four studies were included in the final analysis. A fixed effects model or random effects model was applied to analyze risk ratios (RRs) and hazard ratios (HRs) across studies, and I2 to assess heterogeneity.Results: A total number of 4429 elderly patients with ACS were included in this analysis, of whom 2170 (49.0%) patients received aspirin plus ticagrelor and 2259 (51.0%) received aspirin plus clopidogrel. The ticagrelor group showed a significant advantage over the clopidogrel group concerning all-cause mortality (HR 0.78, 95% CI 0.63–0.96, I2 = 0%; RR 0.79, 95% CI 0.66–0.95, I2 = 0%) and cardiovascular death (HR 0.71, 95% CI 0.56–0.91, I2 = 0%; RR 0.76, 95% CI 0.62–0.94, I2 = 5%) but owned a higher risk of PLATO major or minor bleeding (HR 1.46, 95% CI 1.13–1.89, I2 = 0%; RR 1.40, 95% CI 1.11–1.76, I2 = 0%). Both the groups showed no significant difference regarding major adverse cardiovascular events (MACEs) (HR 1.06, 95% CI 0.68–1.65, I2 = 77%; RR 1.04, 95% CI 0.69–1.58, I2 = 77%).Conclusion: For elderly ACS patients, aspirin plus ticagrelor reduces cardiovascular death and all-cause mortality but increases the risk of bleeding. Herein, aspirin plus ticagrelor may extend lifetime for elderly ACS patients compared with aspirin plus clopidogrel. The optimal DAPT for elderly ACS patients may be a valuable direction for future research studies.

scholarly journals Fractional flow reserve in acute coronary syndrome: a meta-analysis and systematic review

Open Heart ◽  
2019 ◽  
Vol 6 (1) ◽  
pp. e000934 ◽  
Author(s):  
Kevin P Liou ◽  
Sze-Yuan M Ooi ◽  
Stephen P Hoole ◽  
Nick E J West
Keyword(s):  
Acute Coronary Syndrome ◽  
Fractional Flow Reserve ◽  
Meta Analysis ◽  
Major Adverse Cardiovascular Events ◽  
Fractional Flow ◽  
Coronary Syndrome ◽  
Strong Trend ◽  
Flow Reserve ◽  
All Cause Mortality

BackgroundThe utility of fractional flow reserve (FFR) to guide revascularisation in the management of acute coronary syndrome (ACS) remains unclear.ObjectiveThis study aims to compare the clinical outcomes of patients following FFR-guided revascularisation for either ACS or stable angina (SA) and in particular focuses on the outcome of those with deferred revascularisation after FFR.MethodsA meta-analysis of existing literature was performed. Outcomes including the rate of major adverse cardiovascular events (MACE), recurrent myocardial infarction (MI), mortality and unplanned revascularisation were analysed.ResultsA review of 937 records yielded 9 studies comparing 5457 patients, which were included in the analyses. Patients with ACS had a higher rate of recurrent MI (OR 1.81, p=0.02) and a strong trend towards more MACE and all-cause mortality compared with patients with SA when treated by an FFR-guided revascularisation strategy. Deferral of invasive therapy on the basis of FFR led to a higher rate of MACE (17.6% vs 7.3 %; p=0.004), recurrent MI (5.3% vs 1.5%, p=0.001) and target vessel revascularisation (16.4% vs 5.6 %; p=0.02) in patients with ACS, and a strong trend towards a higher cardiovascular mortality at follow-up when compared with patients with SA.ConclusionThe event rate in patients with ACS is much higher than SA despite following an FFR-guided revascularisation strategy. Deferring revascularisation does not appear to be as safe for ACS as it is for SA using contemporary FFR cut-offs validated in SA. Refinement of the therapeutic strategy for patients with ACS with multivessel disease is needed to redress the balance.

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