Abstract 13212: Cardiovascular Benefits of Apabetalone: A Meta-analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Hang Long Li ◽  
Qi Feng ◽  
Yue Fei ◽  
bernard cheung
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Fixed Effects ◽  
Coronary Revascularization ◽  
Meta Analysis ◽  
Phase Iii ◽  
Cochrane Library ◽  
Phase Ii Trials ◽  
Artery Disease

Introduction: Apabetalone is a novel drug that reduces inflammation and thrombosis by inhibiting bromodomain and extra-terminal proteins (BET). Three phase II trials suggested benefits whereas the recent phase III BETonMACE trial did not. To reconcile these differences, we performed a meta-analysis of all trials on apabetalone. Methods: MEDLINE, EMBASE, Cochrane Library, and ClinialTrials.gov were searched for randomized controlled trials of apabetalone up to May 05, 2020. The outcomes of interest were major adverse cardiovascular events (MACE) and hospitalization for heart failure. The secondary outcomes were death, myocardial infarction (MI), coronary revascularization, high-density lipoprotein (HDL) and apolipoprotein A-I (apoA-I). Pooled risk ratios (RRs) or mean differences (MD) in a fixed-effects model were generated using the “ meta ” package in R (version 3.6.3). Results: Four trials (median follow-up 3-26.5 months) with altogether 3223 patients were included. All patients had coronary artery disease and received standard statin therapy. Apabetalone significantly reduced MACE (RR 0.78, 95% CI: 0.63-0.96) and hospitalization for heart failure (RR 0.48, 95% CI: 0.33-0.70) compared to placebo (Fig.). No significant differences were observed for death (RR 0.87, 95% CI: 0.63-1.21), MI (RR 0.82, 95% CI: 0.62-1.10), or coronary revascularization (RR 0.67, 95% CI: 0.31-1.49). Apabetalone increased ApoA-I (MD 2.82%, 95% CI: 1.36-4.28) and HDL (MD 0.04%, 95% CI: 0.02-0.07). Conclusions: Although the BETonMACE trial failed to demonstrate significant benefits, our meta-analysis shows that apabetalone reduces MACE and hospitalization for heart failure in patients with coronary artery disease. Larger outcome trials are urgently needed to investigate the benefits of epigenetic modulation through BET protein inhibition.

scholarly journals Revascularization versus Medical Management of Coronary Artery Disease in Prerenal Transplant Patients: A Meta-Analysis

2018 ◽  
Vol 8 (3) ◽  
pp. 192-198
Author(s):  
Haroon Kamran ◽  
Eric Kupferstein ◽  
Navneet Sharma ◽  
Gagandeep Singh ◽  
James R. Sowers ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Renal Transplantation ◽  
Coronary Artery ◽  
Medical Management ◽  
Odds Ratio ◽  
Patient Population ◽  
Fixed Effects ◽  
Coronary Revascularization ◽  
Meta Analysis ◽  
Artery Disease

Introduction: End-stage renal disease requiring renal transplantation comprises a growing patient population at risk for cardiovascular disease (CVD) morbidity and mortality in large part due to accelerated atherosclerosis. Consequently, these patients are at even higher risk of major surgical CVD mortality. A paucity of research has addressed the posttransplantation CVD outcomes related to different treatment strategies in this patient population and therefore, there are no specific preoperative guidelines regarding management of coronary artery disease in this high-risk population undergoing renal transplantation. Objective: Through meta-analysis we compare coronary revascularization to medical management prior to renal transplantation in patients who are found to have significant obstructive coronary artery disease. Results: A total of 6 studies were deemed suitable out of 777 articles reviewed. This included 260 patients who received medical management and 338 who received coronary revascularization. There were 36 events in the revascularization and 57 events in the medical management group. One study only reported hazard ratios but no CVD outcomes. Comprehensive Meta-Analysis software was used to calculate pooled odds ratio with 95% confidence intervals (CI) for the fixed effects. The data is presented as forest plots. The pooled odds ratio with 95% CI for the fixed effects was 1.415 (95% CI 0.885–2.263), p = 0.147, indicating that there is no difference in CVD outcomes between pretransplant treatment strategy. This observation suggests that the CVD outcomes posttransplantation are not affected when optimal medical therapy is used instead of coronary revascularization.

scholarly journals Sarcopenia predicts adverse outcomes in an elderly population with coronary artery disease: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Qiqi Xue ◽  
Jie Wu ◽  
Yan Ren ◽  
Jiaan Hu ◽  
Ke Yang ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Meta Analysis ◽  
Psoas Muscle ◽  
Coronary Intervention ◽  
Adverse Outcomes ◽  
Cochrane Library ◽  
Muscle Area ◽  
Area Index ◽  
Artery Disease

Abstract Background The development of sarcopenia is attributed to normal aging and factors like type 2 diabetes, obesity, inactivity, reduced testosterone levels, and malnutrition, which are factors of poor prognosis in patients with coronary artery disease (CAD). This study aimed to perform a meta-analysis to assess whether preoperative sarcopenia can be used to predict the outcomes after cardiac surgery in elderly patients with CAD. Methods PubMed, Embase, the Cochrane library, and Web of Science were searched for available papers published up to December 2020. The primary outcome was major adverse cardiovascular outcomes (MACE). The secondary outcomes were mortality and heart failure (HF)-related hospitalization. The random-effects model was used. Hazard ratios (HRs) with 95% confidence intervals (95%CIs) were estimated. Results Ten studies were included, with 3707 patients followed for 6 months to 4.5 ± 2.3 years. The sarcopenia population had a higher rate of MACE compared to the non-sarcopenia population (HR = 2.27, 95%CI: 1.58–3.27, P < 0.001; I2 = 60.0%, Pheterogeneity = 0.02). The association between sarcopenia and MACE was significant when using the psoas muscle area index (PMI) to define sarcopenia (HR = 2.86, 95%CI: 1.84–4.46, P < 0.001; I2 = 0%, Pheterogeneity = 0.604). Sarcopenia was not associated with higher late mortality (HR = 2.15, 95%CI: 0.89–5.22, P = 0.090; I2 = 91.0%, Pheterogeneity < 0.001), all-cause mortality (HR = 1.35, 95%CI: 0.14–12.84, P = 0.792; I2 = 90.5%, Pheterogeneity = 0.001), and death, HF-related hospitalization (HR = 1.37, 95%CI: 0.59–3.16, P = 0.459; I2 = 62.0%, Pheterogeneity = 0.105). The sensitivity analysis revealed no outlying study in the analysis of the association between sarcopenia and MACE after coronary intervention. Conclusion Sarcopenia is associated with poor MACE outcomes in patients with CAD. The results could help determine subpopulations of patients needing special monitoring after CAD surgery. The present study included several kinds of participants; although non-heterogeneity was found, interpretation should be cautious.

scholarly journals Diagnostic Performance of CMR, SPECT, and PET Imaging for the Identification of Coronary Artery Disease: A Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Jianfeng Xu ◽  
Fei Cai ◽  
Changran Geng ◽  
Zheng Wang ◽  
Xiaobin Tang
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Likelihood Ratio ◽  
Subgroup Analysis ◽  
Diagnostic Performance ◽  
Meta Analysis ◽  
Diagnostic Methods ◽  
Cochrane Library ◽  
Emission Computed Tomography ◽  
Artery Disease

Background: Myocardial perfusion imaging modalities, such as cardiac magnetic resonance (CMR), single-photon emission computed tomography (SPECT), and positron emission tomography (PET), are well-established non-invasive diagnostic methods to detect hemodynamically significant coronary artery disease (CAD). The aim of this meta-analysis is to compare CMR, SPECT, and PET in the diagnosis of CAD and to provide evidence for further research and clinical decision-making.Methods: PubMed, Web of Science, EMBASE, and Cochrane Library were searched. Studies that used CMR, SPECT, and/or PET for the diagnosis of CAD were included. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio with their respective 95% confidence interval, and the area under the summary receiver operating characteristic (SROC) curve were calculated.Results: A total of 203 articles were identified for inclusion in this meta-analysis. The pooled sensitivity values of CMR, SPECT, and PET were 0.86, 0.83, and 0.85, respectively. Their respective overall specificity values were 0.83, 0.77, and 0.86. Results in subgroup analysis of the performance of SPECT with 201Tl showed the highest pooled sensitivity [0.85 (0.82, 0.88)] and specificity [0.80 (0.75, 0.83)]. 99mTc-tetrofosmin had the lowest sensitivity [0.76 (0.67, 0.82)]. In the subgroup analysis of PET tracers, results indicated that 13N had the lowest pooled sensitivity [0.83 (0.74, 0.89)], and the specificity was the highest [0.91 (0.81, 0.96)].Conclusion: Our meta-analysis indicates that CMR and PET present better diagnostic performance for the detection of CAD as compared with SPECT.

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