scholarly journals Midterm Outcomes of Early Versus Late Surgery for Infective Endocarditis with Neurologic Complications: A Meta-analysis

2020 ◽  
Author(s):  
Yujiro Yokoyama ◽  
Taichiro Goto
Keyword(s):  
Infective Endocarditis ◽  
Meta Analysis ◽  
Perioperative Period ◽  
Timing Of Surgery ◽  
Optimal Timing ◽  
Neurologic Complications ◽  
Recurrence Rates ◽  
Hazard Ratios ◽  
All Cause Mortality ◽  
Secondary Endpoints

Abstract Background: Cerebral infarction (CI) remains one of the most common and fatal complications of infective endocarditis (IE), and the timing of surgery for IE with neurologic complications is controversial. As outcomes beyond the perioperative period have not been assessed with a meta-analysis previously, we conducted a meta-analysis comparing mid- to long-term outcomes of early and late surgery in patients with IE and neurologic complications.Methods: All studies that investigated early and late surgery in patients with IE and neurologic complications were identified. The primary and secondary endpoints were all-cause mortality and recurrence, respectively. Hazard ratios (HRs) for all-cause mortality and recurrence were extracted from each study. Results: Our search identified five eligible studies, which were all observational studies consisting of a total of 624 patients with IE and neurologic complications. Pooled analyses demonstrated that all-cause mortality was similar between the early and late surgery groups (HR [95% confidence interval [CI]]=0.90 [0.49-1.64]; P=0.10; I2=49%). Similarly, the recurrence rates were similar between both groups (HR [95% CI]=1.86 [0.76-4.52]; P=0.43; I2=0%). Conclusions: Our meta-analysis showed similar mortality and recurrent rates between the early and late surgery groups. The optimal timing of surgery should be individualized on a case-to-case basis.

scholarly journals Midterm outcomes of early versus late surgery for infective endocarditis with neurologic complications: a meta-analysis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yujiro Yokoyama ◽  
Taichiro Goto
Keyword(s):  
Infective Endocarditis ◽  
Meta Analysis ◽  
Perioperative Period ◽  
Timing Of Surgery ◽  
Optimal Timing ◽  
Neurologic Complications ◽  
Recurrence Rates ◽  
Hazard Ratios ◽  
All Cause Mortality ◽  
Secondary Endpoints

Abstract Background Cerebral infarction (CI) remains one of the most common and fatal complications of infective endocarditis (IE), and the timing of surgery for IE with neurologic complications is controversial. As outcomes beyond the perioperative period have not been assessed with a meta-analysis previously, we conducted a meta-analysis comparing mid- to long-term outcomes of early and late surgery in patients with IE and neurologic complications. Methods All studies that investigated early and late surgery in patients with IE and neurologic complications were identified. The primary and secondary endpoints were all-cause mortality and recurrence, respectively. Hazard ratios (HRs) for all-cause mortality and recurrence were extracted from each study. Results Our search identified five eligible studies, which were all observational studies consisting of a total of 624 patients with IE and neurologic complications. Pooled analyses demonstrated that all-cause mortality was similar between the early and late surgery groups (HR [95% confidence interval [CI]] = 0.90 [0.49–1.64]; P = 0.10; I2 = 49%). Similarly, the recurrence rates were similar between both groups (HR [95% CI] = 1.86 [0.76–4.52]; P = 0.43; I2 = 0%). Conclusions Our meta-analysis showed similar mortality and recurrent rates between the early and late surgery groups. The optimal timing of surgery should be individualized on a case-to-case basis.

scholarly journals RISK FACTORS OF ALL-CAUSE MORTALITY AFTER SURGICALLY-TREATED INFECTIVE ENDOCARDITIS: A META-ANALYSIS OF HAZARD RATIOS

2021 ◽  
Vol 77 (18) ◽  
pp. 1774
Author(s):  
Andreas Tzoumas ◽  
Angelos Arfaras-Melainis ◽  
Ioannis Loufopoulos ◽  
Thomas Vasiloulis ◽  
Sanjana Nagraj ◽  
...  
Keyword(s):  
Risk Factors ◽  
Infective Endocarditis ◽  
Meta Analysis ◽  
Hazard Ratios ◽  
All Cause Mortality

Abstract 12572: Early Surgical Treatment versus Initial Conservative Management for Asymptomatic Severe and Very Severe Aortic Stenosis: A Meta-analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yujiro Yokoyama ◽  
Hisato Takagi ◽  
Toshiki Kuno
Keyword(s):  
Aortic Stenosis ◽  
Cardiovascular Mortality ◽  
Severe Aortic Stenosis ◽  
Meta Analysis ◽  
Early Surgery ◽  
Optimal Timing ◽  
Aortic Valve Area ◽  
Conservative Strategy ◽  
Subgroup Analyses ◽  
All Cause Mortality

Background: Although current guidelines generally recommend watchful waiting strategy for patients with asymptomatic severe aortic stenosis (AS) until symptoms develop, the optimal timing of surgical intervention remains controversial. Objective: This study aimed to compare the outcomes of early surgery vs. conservative strategy for patients with asymptomatic severe AS. Methods: MEDLINE and EMBASE were searched through February, 2020 to identify clinical trials that investigatedearly surgery and conservative strategy for patients with asymptomatic severe AS. From each study, we extracted the hazard ratio (HR) of all-cause mortality and cardiovascular mortality. Subgroup analyses were conducted by dividing into severe AS (peak aortic jet velocity [Vmax] ≥4.0 m/s, mean aortic pressure gradient [PG] ≥40 mmHg, or aortic valve area [AVA] ≤1.0 cm 2 ) and very severe AS (Vmax ≥4.5 m/s, mean PG ≥50 mmHg, or AVA ≤0.75 cm 2 ) groups. Results: 1 randomized controlled, 7 observational trials were identified. Pooled analyses demonstrated that all-cause mortality and cardiovascular mortality for early surgery were significantly lower compared to conservative strategy (HR [95% Confidence Interval [CI]] =0.49 [0.36-0.68]; P <0.0001, HR [95% CI] =0.42 [0.22-0.82]; P =0.01, respectively). Subgroup analyses showed significant reduction for early surgery in all-cause mortality (severe AS: HR [95% CI] =0.52 [0.35-0.78]; P =0.001, very severe AS: HR [95% CI] =0.38 [0.17-0.85]; P =0.02). Conclusions: We demonstrated that early surgery was associated with significant reduction in all-cause and cardiovascular mortality in patients with severe AS. Further randomized trials are warranted to confirm our findings.

Statins and Major Adverse Limb Events in Patients with Peripheral Artery Disease: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 120 (05) ◽  
pp. 866-875 ◽  
Author(s):  
Daniele Pastori ◽  
Alessio Farcomeni ◽  
Alberto Milanese ◽  
Francesco Del Sole ◽  
Danilo Menichelli ◽  
...  
Keyword(s):  
Systematic Review ◽  
Peripheral Artery Disease ◽  
Meta Analysis ◽  
Graft Occlusion ◽  
Peripheral Artery ◽  
All Cause Mortality ◽  
Statin Prescription ◽  
Secondary Endpoints ◽  
Artery Disease ◽  
The Impact

Abstract Background Statins are guidelines recommended in patients with peripheral artery disease (PAD) for the prevention of cardiovascular (CV) events. Comprehensive meta-data on the impact of statins on major adverse limb events (MALE) in PAD patients are lacking. We examined the association of statin use with MALE in patients with PAD. Methods We performed a systematic review (registered at PROSPERO: number CRD42019137111) and metanalysis of studies retrieved from PubMed (via MEDLINE) and Cochrane (CENTRAL) databases addressing the impact of statin on MALE including amputation and graft occlusion/revascularization. Secondary endpoints were all-cause death, composite CV endpoints, CV death, and stroke. Results We included 51 studies with 138,060 PAD patients, of whom 48,459 (35.1%) were treated with statins. The analysis included 2 randomized controlled trials, 20 prospective, and 29 retrospective studies. Overall, 11,396 MALE events, 21,624 deaths, 4,852 composite CV endpoints, 4,609 CV deaths, and 860 strokes were used for the analysis. Statins reduced MALE incidence by 30% (pooled hazard ratio [HR]: 0.702; 95% confidence interval [CI]: 0.605–0.815) and amputations by 35% (HR: 0.654; 95% CI: 0.522–0.819), all-cause mortality by 39% (pooled HR: 0.608, 95% CI: 0.543–0.680), CV death by 41% (HR: 0.594; 95% CI: 0.455–0.777), composite CV endpoints by 34% (pooled HR: 0.662; 95% CI: 0.591–0.741) and ischemic stroke by 28% (pooled HR: 0.718; 95% CI: 0.620–0.831). Conclusion Statins reduce the incidence of MALE, all-cause, and CV mortality in patients with PAD. In PAD, a high proportion of MALE events and deaths could be prevented by implementing a statin prescription in this patient population.

scholarly journals Ultra-Processed Food Consumption and Adult Mortality Risk: A Systematic Review and Dose–Response Meta-Analysis of 207,291 Participants

Nutrients ◽  
2021 ◽  
Vol 14 (1) ◽  
pp. 174
Author(s):  
Wanich Suksatan ◽  
Sajjad Moradi ◽  
Fatemeh Naeini ◽  
Reza Bagheri ◽  
Hamed Mohammadi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Dose Response ◽  
Mortality Risk ◽  
Meta Analysis ◽  
Experimental Studies ◽  
Adult Mortality ◽  
Calorie Intake ◽  
Response Analysis ◽  
Hazard Ratios ◽  
All Cause Mortality

We performed a systematic review and dose–response meta-analysis of observational studies assessing the association between UPF consumption and adult mortality risk. A systematic search was conducted using ISI Web of Science, PubMed/MEDLINE, and Scopus electronic databases from inception to August 2021. Data were extracted from seven cohort studies (totaling 207,291 adults from four countries). Using a random-effects model, hazard ratios (HR) of pooled outcomes were estimated. Our results showed that UPF consumption was related to an enhanced risk of all-cause mortality (HR = 1.21; 95% CI: 1.13, 1.30; I2 = 21.9%; p < 0.001), cardiovascular diseases (CVDs)-cause mortality (HR = 1.50; 95% CI: 1.37, 1.63; I2 = 0.0%; p < 0.001), and heart-cause mortality (HR = 1.66; 95% CI: 1.50, 1.85; I2 = 0.0%; p = 0.022), but not cancer-cause mortality. Furthermore, our findings revealed that each 10% increase in UPF consumption in daily calorie intake was associated with a 15% higher risk of all-cause mortality (OR = 1.15; 95% CI: 1.09, 1.21; I2 = 0.0%; p < 0.001). The dose–response analysis revealed a positive linear association between UPF consumption and all-cause mortality (Pnonlinearity = 0.879, Pdose–response = p < 0.001), CVDs-cause mortality (Pnonlinearity = 0.868, Pdose–response = p < 0.001), and heart-cause mortality (Pnonlinearity = 0.774, Pdose–response = p < 0.001). It seems that higher consumption of UPF is significantly associated with an enhanced risk of adult mortality. Despite this, further experimental studies are necessary to draw a more definite conclusion.

scholarly journals AB002. SOH21AS038. Optimal timing of surgery following breast cancer neoadjuvant chemotherapy: a systematic review and meta-analysis

2021 ◽  
Vol 5 ◽  
pp. AB002-AB002
Author(s):  
Carolyn M. Cullinane ◽  
Amber Shrestha ◽  
Ahmed Al Maksoud ◽  
Janice Walsh ◽  
Jane Rothwell ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Neoadjuvant Chemotherapy ◽  
Meta Analysis ◽  
Timing Of Surgery ◽  
Optimal Timing

scholarly journals Risk of all-cause and CHD mortality in women versus men with type 2 diabetes: a systematic review and meta-analysis

2019 ◽  
Vol 180 (4) ◽  
pp. 243-255 ◽  
Author(s):  
Guodong Xu ◽  
Dingyun You ◽  
Liping Wong ◽  
Donghui Duan ◽  
Fanqian Kong ◽  
...  
Keyword(s):  
Systematic Review ◽  
Type 2 Diabetes ◽  
Web Of Science ◽  
Meta Analysis ◽  
Prospective Cohort Studies ◽  
Hazard Ratios ◽  
Inverse Variance ◽  
All Cause Mortality

Objective Previous studies have shown sex-specific differences in all-cause and CHD mortality in type 2 diabetes. We performed a systematic review and meta-analysis to provide a global picture of the estimated influence of type 2 diabetes on the risk of all-cause and CHD mortality in women vs men. Methods We systematically searched PubMed, EMBASE and Web of Science for studies published from their starting dates to Aug 7, 2018. The sex-specific hazard ratios (HRs) and their pooled ratio (women vs men) of all-cause and CHD mortality associated with type 2 diabetes were obtained through an inverse variance-weighted random-effects meta-analysis. Subgroup analyses were used to explore the potential sources of heterogeneity. Results The 35 analyzed prospective cohort studies included 2 314 292 individuals, among whom 254 038 all-cause deaths occurred. The pooled women vs men ratio of the HRs for all-cause and CHD mortality were 1.17 (95% CI: 1.12–1.23, I2 = 81.6%) and 1.97 (95% CI: 1.49–2.61, I2 = 86.4%), respectively. The pooled estimate of the HR for all-cause mortality was approximately 1.30 in articles in which the duration of follow-up was longer than 10 years and 1.10 in articles in which the duration of follow-up was less than 10 years. The pooled HRs for all-cause mortality in patients with type 2 diabetes was 2.33 (95% CI: 2.02–2.69) in women and 1.91 (95% CI: 1.72–2.12) in men, compared with their healthy counterparts. Conclusions The effect of diabetes on all-cause and CHD mortality is approximately 17 and 97% greater, respectively, for women than for men.

Physical function and all-cause mortality in older adults diagnosed with cancer: A systematic review and meta-analysis

2020 ◽  
Author(s):  
Yasmin Ezzatvar ◽  
Robinson Ramírez-Vélez ◽  
Mikel L Sáez de Asteasu ◽  
Nicolás Martínez-Velilla ◽  
Fabricio Zambom-Ferraresi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Physical Function ◽  
Handgrip Strength ◽  
Meta Analysis ◽  
Timed Up And Go ◽  
Hazard Ratios ◽  
Inverse Variance ◽  
All Cause Mortality ◽  
Prospective Association

Abstract Background Physical function is an independent predictor of numerous chronic diseases, but its association with all-cause mortality in older adults diagnosed with cancer has received little attention. Objective The aim of this study was to conduct a systematic review and meta-analysis on the prospective association between physical function and all-cause mortality in older adults diagnosed with cancer. Methods Two authors systematically searched MEDLINE, EMBASE, and SportsDiscus databases. Prospective studies reporting associations of baseline physical function with all-cause mortality in patients aged 60 years or older diagnosed with any type of cancer were included. Hazard Ratios (HR) with associated 95% confidence intervals (CI) were extracted from studies for all-cause mortality and pooled HRs were then calculated using the random-effects inverse-variance model with the Hartung-Knapp-Sidik-Jonkman adjustment. Results Data from 25 studies with 8,109 adults diagnosed with cancer aged ≥60 years were included in the study. Higher levels of physical function (short physical performance battery, HR=0.44 95% CI, 0.29–0.67; I 2=16.0%; timed up and go, HR=0.40 95% CI, 0.31–0.53; I 2=61.9%; gait speed, HR=0.41 95% CI, 0.17–0.96; I 2=73.3%; handgrip strength: HR=0.61 95% CI, 0.43–0.85, I 2=85.6%; and overall, HR=0.45 95% CI, 0.35–0.57; I 2=88.6%) were associated with a lower risk of all-cause mortality compared to lower levels of functionality. Neither age at baseline nor length of follow-up had a significant effect on the HR estimates for lower all-cause mortality risk. Conclusion Physical function may exert an independent protective effect on all-cause mortality in older adults diagnosed with cancer.

Abstract 354: The Effect Of Early Surgery on Outcomes in Infective Endocarditis- A Meta- Analysis of 25,732 Patients

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Waleed T Kayani ◽  
Najia Idrees ◽  
Salman Bandeali ◽  
Don Pham ◽  
Anam Khan ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Surgical Intervention ◽  
Meta Analysis ◽  
Cochrane Collaboration ◽  
Quality Data ◽  
Early Surgery ◽  
All Cause Mortality ◽  
The Subject ◽  
Surgery Mortality ◽  
The Impact

Despite a rising incidence of infective endocarditis (IE), its associated mortality remains high. It is estimated that at least 30% of patients with IE undergo surgery, however data on outcomes of outcomes associated with timing of surgical intervention in this setting is limited. Existing literature mainly consists of observational studies with conflicting results, and current guidelines (ACC/ AHA and Society of Thoracic Surgeons) base recommendations largely on small retrospective studies and expert opinion. We sought to determine the effect of early surgery on outcomes after IE by performing the first comprehensive meta- analysis on the subject. A comprehensive literature search using PubMed (MEDLINE) was performed using keywords “endocarditis”, “surgery”, “mortality” and “outcome”. Early surgery was defined as surgical intervention performed during index hospitalization. Primary outcome of interest was all-cause mortality. Secondary outcomes included incidence of recurrent endocarditis and embolic phenomenon. Of 117 identified studies, 36 met the inclusion criteria (25,732 patients). Data on baseline characteristics and outcomes of interest were extracted. Meta-analysis was performed using Review Manager Version 5.0 (Cochrane Collaboration). Effect sizes for outcomes of interest were estimated using odds ratio (OR) and 95% confidence intervals (CI). Given the inherent heterogeneity among included studies, results from the random effects model are reported. Of the included 25,732 patients, 7,835 underwent early surgery compared to 17,537 who received conventional treatment. A significant reduction in both, short and long term mortality in patients who underwent early surgery OR 0.58 (95% CI 0.47-0.70; p = <0.001) and OR 0.49 (95% CI 0.37-0.65; p = 0.001) respectively was seen. The incidence of recurrent endocarditis or embolic phenomenon did not differ between the two groups. This is the first comprehensive meta-analysis to examine the impact of early surgery on outcomes in patients with IE. Our results indicate that early surgery is associated with a significant reduction in all-cause mortality in patients with IE, without an increase in incidence of recurrent endocarditis. These findings are of clinical significance given paucity of quality data on the subject.

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