Dixitha Anugula

SOTALOL VERSUS OTHER ANTI-ARRHYTHMIC MEDICATIONS FOR CARDIOVERSION OF ATRIAL FIBRILLATION AND MAINTENANCE OF SINUS RHYTHM: META-ANALYSIS OF RANDOMIZED CONTROLLED STUDIES

Background: Sotalol is a class III anti-arrhythmic drug. According to the 2014 AHA/ACC/HRS guidelines on atrial fibrillation (AF), sotalol has a class I recommendation for use in maintenance of sinus rhythm but there are no recommendations regarding its use for pharmacologic cardioversion in AF.

Utilization of the Impella for hemodynamic support during percutaneous intervention and cardiogenic shock: an insight

ABSTRACT Introduction: Impella is a catheter-based micro-axial flow pump placed across the aortic valve, and it is currently the only percutaneous left ventricular assist device approved for high-risk percutaneous coronary intervention and cardiogenic shock. Areas Covered: Even though several studies have repeatedly demonstrated the excellent hemodynamic profile of Impella in high-risk settings, it remains underutilized. Here we aim to provide an up-to-date summary of the available literature on Impellas use in High risk settings as well as the practical aspects of its usage. Expert Commentary: Percutaneous coronary interventions in high rsk settings have always been challenging for a physician. Impella 2.5 and CP, have been proven safe, cost effective and feasible in High Risk Percutaneous coronary Interventions with an excellent hemodynamic profile.

Patent foramen ovale closure reduces recurrent stroke risk in cryptogenic stroke: A systematic review and meta-analysis of randomized controlled trials

AIM To investigate if patent foramen ovale (PFO) closure device reduces the risk of recurrent stroke in patients with cryptogenic stroke. METHODS We searched five databases - PubMed, EMBASE, Cochrane, CINAHL and Web-of-Science and clinicaltrials.gov from January 2000 to September 2017 for randomized trials comparing PFO closure to medical therapy in cryptogenic stroke. Heterogeneity was determined using Cochrane’s Q statistics. Random effects model was used. RESULTS Five randomized controlled trials with 3440 patients were included in the analysis. Mean follow-up was 50 ± 20 mo. PFO closure was associated with a 41% reduction in incidence of recurrent strokes when compared to medical therapy alone in patients with cryptogenic stroke [risk ratio (RR): 0.59, 95%CI: 0.40-0.87, P = 0.008]. Atrial fibrillation was higher with device closure when compared to medical therapy alone (RR: 4.97, 95%CI: 2.22-11.11, P < 0.001). There was no difference between the two groups with respect to all-cause mortality, major bleeding or adverse events. CONCLUSION PFO device closure in appropriately selected patients with moderate to severe right-to-left shunt and/or atrial septal aneurysm shows benefit with respect to recurrent strokes, particularly in younger patients. Further studies are essential to evaluate the impact of higher incidence of atrial fibrillation seen with the PFO closure device on long-term mortality and stroke rates.

Bivalirudin versus heparin in percutaneous coronary intervention—a systematic review and meta-analysis of randomized trials stratified by adjunctive glycoprotein IIb/IIIa strategy

BackgroundnBivalirudin has been shown to be associated with less major bleeding than heparin in patients undergoing percutaneous coronary intervention (PCI); but the confounding effect of concomitant glycoprotein IIb/IIIa inhibitors (GPI) limits meaningful comparison. We performed a systematic review and meta-analysis to compare bivalirudin to heparin, with and without adjunctive GPI in PCI.nnnMethodsnWe searched PubMed, Cochrane, EMBASE, CINAHL and WOS from January 2000 to December 2017 for clinical trials comparing bivalirudin to heparin, with and without adjunctive GPI during PCI. Cochranes Q statistics were used to determine heterogeneity. Random effects model was used.nnnResultsnTwenty-six comparison groups (22 original studies and 4 subgroup analyses) with 53,364 patients were included. Mean follow-up was 192±303 days. There was no difference between the two groups in all-cause mortality [risk ratio (RR: 0.93; 95% CI: 0.82-1.05, P=0.260), target vessel revascularization (TVR) (RR: 1.17; 95% CI: 0.93-1.46, P=0.174) or stroke (RR: 0.91; 95% CI: 0.71-1.18, P=0.490). Major bleeding was lower in the bivalirudin group with concomitant GPI in one or both arms (RR: 0.64; 95% CI: 0.53-0.77, P<0.001) and without (RR: 0.71; 95% CI: 0.51-0.99, P=0.041) provisional or routine GPIs. Bivalirudin appeared to have a higher risk of stent thrombosis (RR: 1.32; 95% CI: 1.04-1.68, P=0.022) and a trend towards more myocardial infarction (RR: 1.12; 95% CI: 0.98-1.28, P=0.098) though without statistical significance. However, exclusion of studies with GPI showed no difference in stent thrombosis or myocardial infarction with bivalirudin.nnnConclusionsnBivalirudin is associated with less major bleeding compared to heparin, regardless of GPI use. The lower anticoagulant effect of bivalirudin is linked with higher stent thrombosis and a trend towards more MI, however a confounding effect of GPI use in the heparin arm cannot be excluded.

Operator Experience and Outcomes After Left Main Percutaneous Coronary Intervention

Purpose of ReviewThis review was performed with the goal of summarizing the role of operator experience in the treatment of severe left main stenosis by percutaneous intervention techniques.Recent FindingsThe Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial demonstrated that percutaneous coronary intervention and coronary artery bypass grafting had similar clinical outcomes for severe left main disease. However, PCI of the left main coronary stenosis is considered to be a high-risk intervention because of the large area of myocardium at jeopardy that can quickly cause hemodynamic compromise. Operator experience and familiarity with the use of hemodynamic support devices, plaque modification techniques, and intravascular imaging tools is associated with better clinical outcomes.SummaryIn patients with severe left main stenosis undergoing percutaneous coronary intervention by high-volume operators, the clinical outcomes are superior.

PROGNOSTIC IMPACT OF PREMATURE ATRIAL COMPLEXES IN THE GENERAL POPULATION: A META-ANALYSIS OF OBSERVATIONAL STUDIES

Background: Premature Atrial Complexes (PACs) are frequently observed on routine ECGs and holter monitors. However, their prognostic significance in healthy individuals is not fully elucidated. We performed this Meta-Analysis to assess the impact of PACs on cardiovascular outcomes.nnMethods:

TCT-298 Successful Versus Unsuccessful Percutaneous Coronary Intervention of Chronic Total Occlusions: A Contemporary Meta-Analysis.

METHODS We performed a multicenter prospective study enrolling 839 CTO patients attempted percutaneously between January 2013 and December 2015. Patients were subdivided into 3 groups according to LVEF : group 1 (LVEF>50%), group 2 (LVEF 35-50%) and group 3 (LVEF<35%). Baseline clinical and angiographic characteristics, procedural details, success rate and in-hospital outcome were compared between groups. J-CTO score was used to assess CTO lesion complexity. In CTO patients with LVEF<35% successfully revascularized, clinical follow-up was performed. Major adverse cardiac and cardiovascular events (MACCE) were defined as the composite of cardiac death, myocardial infarction (MI) and target vessel revascularization. Angiographic follow-up was performed either systematically or driven by ischemia.