scholarly journals Title: An Umbrella Review of Clinical Efficacy and Adverse Cardiac Events Associated with Hydroxychloroquine or Chloroquine with or Without Azithromycin in Patients with COVID-19

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Kavous Shahsavarinia ◽  
Morteza Ghojazadeh ◽  
Amir Ghabousian ◽  
Faezeh Hatefnia ◽  
Maryam Soleimanpour ◽  
...  
Keyword(s):  
Clinical Efficacy ◽  
Web Of Science ◽  
Meta Analysis ◽  
Treatment Strategies ◽  
Umbrella Review ◽  
Cardiac Events ◽  
Advantages And Disadvantages ◽  
Adverse Cardiac Events ◽  
Repurposed Drugs ◽  
Arrhythmogenic Potential

Context: The safety and efficacy of several repurposed drugs, including hydroxychloroquine and chloroquine, with or without azithromycin, were presumed to be miraculous in treating patients with COVID-19. However, as it later transpired, these therapeutic agents seem to be associated with critical adverse cardiac events. Objectives: Given the skepticism around the advantages and disadvantages of the aforementioned treatment strategies, the present study aimed to investigate the clinical efficacy and cardiac toxicity of hydroxychloroquine or chloroquine with or without azithromycin in the setting of COVID-19 infection. Method: This was an umbrella review conducted on patients with COVID-19 who received hydroxychloroquine or chloroquine with or without azithromycin from January 2020 to November 2020. We systematically searched PubMed, Scopus, Cochrane, ProQuest, Web of Science, and Embase databases. Results: Three studies (systematic review and meta-analysis) were analyzed to evaluate the arrhythmogenic potential of hydroxychloroquine or chloroquine with or without azithromycin in patients with COVID-19 and identify the clinical efficacy of such a combination. Conclusions: We found no benefit for patients with COVID-19 who received hydroxychloroquine or chloroquine alone or in combination with azithromycin. Moreover, it is noteworthy that these medications, particularly when considering co-administration, could result in both statistically and clinically elevated risks of notorious arrhythmias, such as TdP.

scholarly journals Major Adverse Cardiac Events and Mortality Associated with Electroconvulsive Therapy

2019 ◽  
Vol 130 (1) ◽  
pp. 83-91 ◽  
Author(s):  
Andreas Duma ◽  
Mathias Maleczek ◽  
Basil Panjikaran ◽  
Harald Herkner ◽  
Theodore Karrison ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Edema ◽  
Acute Heart Failure ◽  
Electroconvulsive Therapy ◽  
Meta Analysis ◽  
Incidence Rates ◽  
Major Adverse Cardiac Events ◽  
Cardiac Events ◽  
Total N ◽  
Adverse Cardiac Events

Abstract EDITOR’S PERSPECTIVE What We Already Know about This Topic The incidence of major adverse cardiac events after electroconvulsive therapy is not known What This Article Tells Us That Is New Major adverse cardiac events and death after electroconvulsive therapy are infrequent and occur in about 1 of 50 patients and after about 1 of 200 to 500 electroconvulsive therapy treatments Background Cardiac events after electroconvulsive therapy have been reported sporadically, but a systematic assessment of the risk is missing. The goal of this study was to obtain a robust estimate of the incidence of major adverse cardiac events in adult patients undergoing electroconvulsive therapy. Methods Systematic review and meta-analysis of studies that investigated electroconvulsive therapy and reported major adverse cardiac events and/or mortality. Endpoints were incidence rates of major adverse cardiac events, including myocardial infarction, arrhythmia, pulmonary edema, pulmonary embolism, acute heart failure, and cardiac arrest. Additional endpoints were all-cause and cardiac mortality. The pooled estimated incidence rates and 95% CIs of individual major adverse cardiac events and mortality per 1,000 patients and per 1,000 electroconvulsive therapy treatments were calculated. Results After screening of 2,641 publications and full-text assessment of 284 studies, the data of 82 studies were extracted (total n = 106,569 patients; n = 786,995 electroconvulsive therapy treatments). The most commonly reported major adverse cardiac events were acute heart failure, arrhythmia, and acute pulmonary edema with an incidence (95% CI) of 24 (12.48 to 46.13), 25.83 (14.83 to 45.00), and 4.92 (0.85 to 28.60) per 1,000 patients or 2.44 (1.27 to 4.69), 4.66 (2.15 to 10.09), and 1.50 (0.71 to 3.14) per 1,000 electroconvulsive therapy treatments. All-cause mortality was 0.42 (0.11 to 1.52) deaths per 1,000 patients and 0.06 (0.02 to 0.23) deaths per 1,000 electroconvulsive therapy treatments. Cardiac death accounted for 29% (23 of 79) of deaths. Conclusions Major adverse cardiac events and death after electroconvulsive therapy are infrequent and occur in about 1 of 50 patients and after about 1 of 200 to 500 electroconvulsive therapy treatments.

Abstract 16260: Thirty Days Major Adverse Cardiac Events Following Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Non-ste-acute Coronary Syndrome: A Meta-analysis With Meta-regression

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Kiro Barssoum ◽  
Ashish Kumar ◽  
Devesh Rai ◽  
Adnan Kharsa ◽  
Medhat Chowdhury ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Meta Analysis ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Cardiac Events ◽  
Coronary Syndrome ◽  
Adverse Cardiac Events ◽  
History Of ◽  
Meta Regression ◽  
Meta Regression Analysis

Background: The optimum revascularization modality in multi-vessel and left main disease patients presenting with non-ST elevation acute coronary syndrome (non-STE-ACS) is not well studied. The current recommendations are based on studies that primarily included patients with stable angina. Patients with non-STE-ACS were under-represented in clinical trials. We performed a meta-analysis of studies comparing coronary artery bypass grafting (CABG) vs. percutaneous coronary intervention (PCI) in non-STE-ACS, and reporting 30 days major adverse cardiac events (MACE). Methods: We searched Medline, EmCare, CINAHL, Cochrane database, and Google Scholar for relevant articles. We excluded studies that included patients with stable coronary artery disease and ST elevation myocardial infarction. Our primary outcome was 30 days MACE defined as all-cause death, stroke, repeat revascularization and re-infarction. We used the Paule-Mandel method with the Hartung-Knapp-Sidik-Jonkman adjustment to estimate risk ratio (RR) with a 95% confidence interval (CI). Heterogeneity was assessed using Higgin’s I 2 statistics. To account for heterogeneity, a meta-regression analysis was performed. Results: Five observational studies met our inclusion criteria summing to a total number of 7161 patients. At 30 days, there was no difference between CABG vs. PCI in terms of MACE, RR: 0.96, 95% CI 0.38 to 2.39, I 2 = 81% (Panel A). A meta-regression analysis reported that a history of PCI was associated with a lower risk of MACE with CABG compared to PCI (Panel B). Conclusion: At 30 days, there was no difference in MACE between the CABG and PCI groups. However, a history of PCI was associated with a lower risk of MACE in patients who underwent CABG.

P276 A meta-analysis on the association of febuxostat compared to allopurinol on blood pressure and major adverse cardiac events (MACE) among adult patients with hyperuricemia

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
M Barrientos ◽  
R A Macabeo ◽  
R A Ragasa
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Uric Acid ◽  
Meta Analysis ◽  
Adult Patients ◽  
Cardiac Events ◽  
Lowering Therapy ◽  
Adverse Cardiac Events ◽  
All Cause Mortality

Abstract Background Increased uric acid levels have been known to be associated with different cardiovascular and renal diseases.  Over the last few years, several studies have examined the role of urate-lowering therapy (ULT) in hypertension and Major Adverse Cardiac Events (MACE) and results are pointing to a potential role of elevated serum uric acid as an emerging independent cardiovascular risk factor. Objective  To determine if urate-lowering therapy (Febuxostat vs Allopurinol) has an association on blood pressure and MACE among adult patients with hyperuricemia. Methodology Randomized controlled trials with outcomes of blood pressure, all-cause mortality, myocardial infarction, and stroke were searched through PubMed and Cochrane database. Results Pooled analysis of studies on hyperuricemic patients showed that Febuxostat 40 mg has no significant difference compared with Allopurinol 100/300mg with respect to lowering diastolic (MD -0.56 with 95% CI of -4.28 to 3.15) and systolic blood pressure (MD -0.72 with 95% CI of -4.87 to 6.31).  No significant differences were also noted on all-cause mortality (OR 1.21 with 95% CI of 0.35 to 4.12) and myocardial infarction (MI) (OR 1.38 with 95% CI of 0.19 to 9.94). Outcomes on non-fatal stroke were only reported by Becker, et. al (2010) with only 2 events reported in the Febuxostat 80 mg group (0.26%) and no event in the Allopurinol group (CI= 0.082 to 1.155). Conclusion The results of this meta-analysis showed that urate-lowering therapy (Febuxostat vs Allopurinol) has no significant association on blood pressure among adult patients with hyperuricemia.  No significant association was also found with respect to all-cause mortality and MI. Outcomes on stroke were inconclusive since only one study reported on its events.

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