Peng-Ju Wang

Meta-Analysis of Relation Between Oral β-Blocker Therapy and Outcomes in Patients With Acute Myocardial Infarction Who Underwent Percutaneous Coronary Intervention

The aim of the present review was to investigate the association between the use of oral β-blockers and prognosis in patients with acute myocardial infarction (AMI) who underwent percutaneous coronary intervention (PCI) treatment. A systematic literature search was conducted in Pubmed (from inception to September 27, 2014) and Embase (Ovid SP, from 1974 to September 29, 2014) to identify studies that compared the outcome of patients with AMI taking oral β-blockers with that of patients not taking after PCI. Systematic review and meta-analysis were performed with random-effects model or fixed-effects model. Ten observational studies with a total of 40,873 patients were included. Use of β-blockers was associated with a reduced risk of all-cause death (unadjusted relative risk 0.58, 95% confidential interval 0.48 to 0.71; adjusted hazard ratio 0.76, 95% confidential interval 0.62 to 0.94). The potential benefit of β-blockers in preventing all-cause death was not similar in all population but was restricted to those with reduced ejection fraction, with low use proportion of other secondary prevention drugs or with non-ST-segment elevation myocardial infarction. The association between the use of β-blockers and improved survival rate was significant in ≤1-year follow-up duration. Rates of cardiac death, myocardial infarction, and heart failure readmission in patients using β-blockers were not significantly different from those in patients without β-blocker therapy. In conclusion, there is lack of evidence to support routine use of β-blockers in all patients with AMI who underwent PCI. Further trials are urgently needed to address the issue.

The efficacy and safety of prehospital therapeutic hypothermia in patients with out-of-hospital cardiac arrest: A systematic review and meta-analysis

BACKGROUND The benefit of therapeutic hypothermia (TH) to patients suffering out-of-hospital cardiac arrest (OHCA) has been well established. However, the effect of prehospital cooling remains unclear. We aimed to investigate the efficacy and safety of prehospital TH for OHCA patients by conducting a systematic review of randomised controlled trials (RCTs). METHODS The MEDLINE, EMbase and CENTRAL databases were searched for publications from inception to April 2015. RCTs that compared cooling with no cooling in a prehospital setting among adults with OHCA were eligible for inclusion. Random- and fixed-effect models were used depending on inter-study heterogeneity. RESULTS Eight trials that recruited 2379 participants met the inclusion criteria. Prehospital TH was significantly associated with a lower temperature at admission (mean difference (MD) -0.94; 95% confidence interval (CI) -1.06 to -0.82). However, survival upon admission (Risk ratio (RR) 1.01, 95%CI 0.98-1.04), survival at discharge (RR 1.02, 95%CI 0.91-1.14), in-hospital survival (RR 1.05, 95%CI 0.92-1.19) and good neurological function recovery (RR 1.06, 95% CI 0.91-1.23) did not differ between the TH-treated and non-treated groups. Prehospital cooling increased the incidence of recurrent arrest (RR 1.23, 95%CI 1.02-1.48) and decreased the PH at admission (MD -0.04, 95%CI -0.07 to -0.02). Pulmonary oedema did not differ between the arms (RR 1.02, 95%CI 0.67-1.57). None of the potentially controversial issues (cooling methods, time of inducing TH, the proportion of continuing cooling in hospital, actual prehospital infusion volume and primary cardiac rhythms) affected the efficacy. CONCLUSION Evidence does not support the administration of prehospital TH to patients with OHCA.

Gender Disparity in the Safety and Efficacy of Radial and Femoral Access for Coronary Intervention: A Systematic Review and Meta-Analysis

Our aim was to investigate the gender disparity in the safety and efficacy of transradial percutaneous coronary intervention (PCI; TRI) and transfemoral PCI (TFI) by a meta-analysis. MEDLINE, Embase, and CENTRAL were searched to identify studies on vascular access with sex-specific events available or studies on sex difference with the events reported by vascular access. Fifteen studies involving 3 921 848 participants were included. Transradial PCI significantly reduced the risk of bleeding complications in both sexes (TRI-versus-TFI odds ratio [OR]: 0.37 in females vs 0.47 in males) and major adverse cardiac events (MACE) in females (OR: 0.70, P < .001) but not in males (OR: 0.83, P = .15) compared to TFI. Transradial PCI diminished the sex difference in the incidence of bleeding complications (female-versus-male OR: 1.82 with TRI vs 2.39 with TFI; interaction P = .01) and MACE (female-versus-male OR: 1.21 with TRI vs 1.41 with TFI; interaction P = .003) compared to TFI. Females were associated with higher crossover rate in the TRI subgroup but not in the TFI subgroup (interaction P = .05). In conclusion, TRI may improve the safety and efficacy of outcomes in both sexes and be an effective means to cut down the gender difference in prognosis.

Subclassification of left ventricular hypertrophy based on dilation stratifies coronary artery disease patients with distinct risk.

A new 4‐tired classification of left ventricular hypertrophy (LVH) based on LV concentricity and dilation has been proposed; however, the association between the new categorization of LV geometry and outcomes in patients with coronary artery disease (CAD) is still unknown.

The Prognosis of Patients With Nonobstructive Coronary Artery Disease Versus Normal Arteries Determined by Invasive Coronary Angiography or Computed Tomography Coronary Angiography: A Systematic Review.

AbstractLimited data exist regarding the outcomes of patients with nonobstructive coronary artery disease (CAD) detected by computed tomography coronary angiography (CTCA) or invasive coronary angiography (ICA).Our aim was to compare the prognosis of patients with nonobstructive coronary artery plaques with that of patients with entirely normal arteries.The MEDLINE, Cochrane Library, and Embase databases were searched. Studies comparing the prognosis of individuals with nonobstructive CAD versus normal coronary arteries detected by CTCA or ICA were included. The primary outcome was major adverse cardiac events (MACE) including cardiac death, nonfatal myocardial infarction, hospitalization due to unstable angina or revascularization. A fixed effects model was chosen to pool the estimates of odds ratios (ORs).Forty-eight studies with 64,905 individuals met the inclusion criteria. Patients in the nonobstructive CAD arm had a significantly higher risk of MACE compared to their counterparts in the normal artery arm (pooled OR, 3.17, 95% confidence interval, 2.77–3.63). When excluding revascularization as an endpoint, hard cardiac composite outcomes were also more frequent among patients with nonobstructive CAD (pooled OR, 2.10; 95%CI, 1.79–2.45). All subgroups (age, sex, follow-up duration, different outcomes, diagnostic modality, and CAD risk factor) consistently showed a poorer prognosis with nonobstructive CAD than with normal arteries. When dividing the studies into a CTCA and ICA group for further analysis based on the indications for diagnostic tests, we also found nonobstructive CAD to be associated with a higher risk of MACE in both stable and acute chest pain.Patients with nonobstructive CAD had a poorer prognosis compared with their counterparts with normal arteries.

Heparin is Not Inferior to Bivalirudin in Percutaneous Coronary Intervention—Focusing on the Effect of Glycoprotein IIb/IIIa Inhibitor Use A Meta-Analysis

Our aim was to compare the efficacy and safety of bivalirudin (Biv) versus heparin (Hep) with or without similar usage rate of glycoprotein IIb/IIIa inhibitors (GPIs) during percutaneous coronary intervention (PCI). The PubMed and EMbase were searched. Randomized trials comparing Biv versus Hep were eligible for inclusion. With imbalanced GPI use, Biv had significantly lower major bleeding (pooled risk ratio [RR], 0.67; 95% confidence interval [CI], 0.54-0.83) without difference in mortality (pooled RR, 0.95; 95% CI, 0.80-1.14). With comparable GPI use, no significant difference was observed in major bleeding (pooled RR, 0.95; 95% CI, 0.82-1.10) and mortality (pooled RR, 1.13; 95% CI, 0.85-1.50). With no GPI use, Biv was associated with numerically higher mortality (pooled RR, 1.17; 95% CI, 0.83-1.65) without significant difference in major bleeding (pooled RR, 0.81; 95% CI, 0.64-1.02). In conclusion, when comparing different anticoagulants during PCI, the effect of GPIs should not be underestimated. Heparin as such was found noninferior to Biv.

Target lesion calcification and risk of adverse outcomes in patients with drug-eluting stents. A meta-analysis.

BackgroundStudies focusing on the relationship between calcified lesions and adverse outcomes in the drug-eluting stent (DES) era have presented inconsistent conclusions. The aim of this study was to assess the association between target lesion calcification and adverse outcomes in patients undergoing DES implantation.MethodsA systematic search was conducted on Medline (Ovid SP, 1946 to 28 February 2014), Embase (Ovid SP, 1974 to 28 February 2014), and the Chinese Biomedical Literature Database (CBM, 1978 to 28 February 2014). Abstracts from the 2012 and 2013 scientific meetings of the American College of Cardiology and American Heart Association were manually searched. Hazard ratios (HRs) were pooled using a fixed or random effects model in the context of heterogeneity.ResultsA total of 13 studies comprising 66,361 patients were included. Target lesion calcification was associated with an increased risk of all-cause mortality (HR = 1.41; 95 % CI = 1.27–1.56), cardiac death (HR = 1.97; 95 % CI = 1.68–2.31), myocardial infarction (HR = 1.33; 95 % CI = 1.13–1.57), target lesion revascularization (TLR; HR 1.47, 95 % CI 1.18–1.83), stent thrombosis (HR 1.63, 95 % CI 1.36–1.96), and major cardiovascular events (HR 1.37, 95 % CI 1.19–1.58). The results proved robust in subgroup analyses for TLR and stent thrombosis.ConclusionCalcified target lesions are risk factors for adverse outcomes in the DES era. Further studies focusing on comprehensive therapy in patients with coronary calcification are urgently needed.ZusammenfassungZielZiel der Studie war es, den Zusammenhang zwischen der Kalzifizierung von Zielläsionen und einem ungünstigen Verlauf bei Patienten zu untersuchen, bei denen ein medikamentenbeschichteter Stent („drug-eluting stent“, DES) eingesetzt wurde.HintergrundStudien mit Fokus auf der Beziehung zwischen kalzifizierten Läsionen und ungünstigem Verlauf im Zeitalter der DES ergaben widersprüchliche Schlussfolgerungen.MethodenEs wurde eine systematische Suche in Medline (Ovid SP, 1946 bis 28. Februar 2014), Embase (Ovid SP, 1974 bis 28. Februar 2014) und der Chinese Biomedical Literature Database (CBM, 1978 bis 28. Februar 2014) durchgeführt. Manuell durchsucht wurden die Zusammenfassungen als Supplement von den Kongressen des American College of Cardiology und der American Heart Association aus den Jahren 2012 und 2013. Die Hazard Ratios (HR) wurden unter Verwendung eines Random-Effects-Modells vor dem Hintergrund der Heterogenität zusammengefasst.ErgebnisseAusgewertet wurden 13 Studien mit 66.361 Patienten. Die Kalzifizierung einer Zielläsion ging einher mit einem erhöhten Risiko für die Mortalität aus sämtlichen Ursachen (HR: 1,41; 95 %-Konfidenzintervall, 95 %-KI: 1,27–1,56), Herztod (HR: 1,97; 95 %-KI: 1,68–2,31), Myokardinfarkt (HR: 1,33; 95 %-KI: 1,13–1,57), Revaskularisierung der Zielläsion („target lesion revascularization“, TLR; HR: 1,47; 95 %-KI: 1,18–1,83), Stentthrombose (HR: 1,63; 95 %-KI: 1,36–1,96) und schwere kardiovaskuläre Ereignisse (HR: 1,37; 95 %-KI: 1,19–1,58). Die Ergebnisse erwiesen sich in Subgruppenanalysen für TLR und Stentthrombose als robust.SchlussfolgerungKalzifizierte Zielläsionen sind auch im Zeitalter der DES immer noch Risikofaktoren für einen ungünstigen Verlauf. Weitere Studien mit Schwerpunkt auf einer umfassenden Therapie bei Patienten mit Koronararterienverkalkungen sind dringend erforderlich.

Relation between admission plasma fibrinogen levels and mortality in Chinese patients with coronary artery disease.

Fibrinogen (Fib) was considered to be a potential risk factor for the prognosis of patients with coronary artery disease (CAD), but there was lack of the evidence from Chinese contemporary population. 3020 consecutive patients with CAD confirmed by coronary angiography were enrolled and were grouped into 2 categories by the optimal Fib cut-off value (3.17 g/L) for all-cause mortality prediction. The end points were all-cause mortality and cardiac mortality. Cumulative survival curves showed that the risk of all-cause mortality was significantly higher in patients with Fib ≥3.17 g/L compared to those with Fib <3.17 g/L (mortality rate, 11.5% vs. 5.7%, p < 0.001); and cardiovascular mortality obtained results similar to those mentioned above (cardiac mortality rate, 5.9% vs. 3.6%, p = 0.002). Subgroup analysis showed that elevated Fib levels were predictive for the risk of all-cause mortality in the subgroups according to age, medical history, and diagnosis. COX multivariate regression analysis showed that plasma Fib levels remained independently associated with all-cause mortality after adjustment for multiple cardiovascular risk factors (all-cause mortality, HR 2.01, CI 1.51–2.68, p < 0.001). This study has found that Fib levels were independently associated with the mortality risk in Chinese CAD patients.

Increased interventricular septum wall thickness predicts all‐cause death in patients with coronary artery disease

There is debate regarding the predictive value of interventricular septum (IVS) wall thickness for adverse events.

Target lesion calcification and risk of adverse outcomes in patients with drug-eluting stents

BackgroundStudies focusing on the relationship between calcified lesions and adverse outcomes in the drug-eluting stent (DES) era have presented inconsistent conclusions. The aim of this study was to assess the association between target lesion calcification and adverse outcomes in patients undergoing DES implantation.MethodsA systematic search was conducted on Medline (Ovid SP, 1946 to 28 February 2014), Embase (Ovid SP, 1974 to 28 February 2014), and the Chinese Biomedical Literature Database (CBM, 1978 to 28 February 2014). Abstracts from the 2012 and 2013 scientific meetings of the American College of Cardiology and American Heart Association were manually searched. Hazard ratios (HRs) were pooled using a fixed or random effects model in the context of heterogeneity.ResultsA total of 13 studies comprising 66,361 patients were included. Target lesion calcification was associated with an increased risk of all-cause mortality (HR = 1.41; 95 % CI = 1.27–1.56), cardiac death (HR = 1.97; 95 % CI = 1.68–2.31), myocardial infarction (HR = 1.33; 95 % CI = 1.13–1.57), target lesion revascularization (TLR; HR 1.47, 95 % CI 1.18–1.83), stent thrombosis (HR 1.63, 95 % CI 1.36–1.96), and major cardiovascular events (HR 1.37, 95 % CI 1.19–1.58). The results proved robust in subgroup analyses for TLR and stent thrombosis.ConclusionCalcified target lesions are risk factors for adverse outcomes in the DES era. Further studies focusing on comprehensive therapy in patients with coronary calcification are urgently needed.ZusammenfassungZielZiel der Studie war es, den Zusammenhang zwischen der Kalzifizierung von Zielläsionen und einem ungünstigen Verlauf bei Patienten zu untersuchen, bei denen ein medikamentenbeschichteter Stent („drug-eluting stent“, DES) eingesetzt wurde.HintergrundStudien mit Fokus auf der Beziehung zwischen kalzifizierten Läsionen und ungünstigem Verlauf im Zeitalter der DES ergaben widersprüchliche Schlussfolgerungen.MethodenEs wurde eine systematische Suche in Medline (Ovid SP, 1946 bis 28. Februar 2014), Embase (Ovid SP, 1974 bis 28. Februar 2014) und der Chinese Biomedical Literature Database (CBM, 1978 bis 28. Februar 2014) durchgeführt. Manuell durchsucht wurden die Zusammenfassungen als Supplement von den Kongressen des American College of Cardiology und der American Heart Association aus den Jahren 2012 und 2013. Die Hazard Ratios (HR) wurden unter Verwendung eines Random-Effects-Modells vor dem Hintergrund der Heterogenität zusammengefasst.ErgebnisseAusgewertet wurden 13 Studien mit 66.361 Patienten. Die Kalzifizierung einer Zielläsion ging einher mit einem erhöhten Risiko für die Mortalität aus sämtlichen Ursachen (HR: 1,41; 95 %-Konfidenzintervall, 95 %-KI: 1,27–1,56), Herztod (HR: 1,97; 95 %-KI: 1,68–2,31), Myokardinfarkt (HR: 1,33; 95 %-KI: 1,13–1,57), Revaskularisierung der Zielläsion („target lesion revascularization“, TLR; HR: 1,47; 95 %-KI: 1,18–1,83), Stentthrombose (HR: 1,63; 95 %-KI: 1,36–1,96) und schwere kardiovaskuläre Ereignisse (HR: 1,37; 95 %-KI: 1,19–1,58). Die Ergebnisse erwiesen sich in Subgruppenanalysen für TLR und Stentthrombose als robust.SchlussfolgerungKalzifizierte Zielläsionen sind auch im Zeitalter der DES immer noch Risikofaktoren für einen ungünstigen Verlauf. Weitere Studien mit Schwerpunkt auf einer umfassenden Therapie bei Patienten mit Koronararterienverkalkungen sind dringend erforderlich.