Rhanderson Cardoso

Incidence of cardiovascular events and gastrointestinal bleeding in patients receiving clopidogrel with and without proton pump inhibitors: an updated meta-analysis.

Background Dual antiplatelet therapy is the standard of care after coronary stent placement but increases the bleeding risk. The effects of proton pump inhibitors (PPIs) on clopidogrel metabolism have been described, but the clinical significance is not yet definitive. We aimed to do an updated meta-analysis comparing outcomes in patients receiving clopidogrel with and without PPIs. Methods We systematically searched PubMed, Scopus and the Cochrane Central Register of Controlled Trials for randomised controlled trials (RCTs) and controlled observational studies in patients taking clopidogrel stratified by concomitant PPI use. Heterogeneity was examined with the Cochran Q test and I2 statistics; p values inferior to 0.10 and I2 >25% were considered significant for heterogeneity. Results We included 39 studies with a total of 214u2005851 patients, of whom 73u2005731 (34.3%) received the combination of clopidogrel and a PPI. In pooled analysis, all-cause mortality, myocardial infarction, stent thrombosis and cerebrovascular accidents were more common in patients receiving both drugs. However, among 23u2005552 patients from eight RCTs and propensity-matched studies, there were no significant differences in mortality or ischaemic events between groups. The use of PPIs in patients taking clopidogrel was associated with a significant reduction in the risk of gastrointestinal bleeding. Conclusions The results of our meta-analysis suggest that PPIs are a marker of increased cardiovascular risk in patients taking clopidogrel, rather than a direct cause of worse outcomes. The pharmacodynamic interaction between PPIs and clopidogrel most likely has no clinical significance. Furthermore, PPIs have the potential to decrease gastrointestinal bleeding in clopidogrel users.

Percutaneous Pulmonary Valve Implantation : Present Status and Evolving Future

Due to recurrent right ventricular outflow tract (RVOT) dysfunction, patients with complex congenital heart disease of the RVOT traditionally require multiple surgical interventions during their lifetimes. Percutaneous pulmonary valve implantation (PPVI) has been developed as a nonsurgical alternative for the treatment of right ventricular to pulmonary artery stenosis or pulmonary regurgitation. PPVI has been shown to be a safe and effective procedure in patients with dysfunctional surgical RVOT conduits. In this population, PPVI has the potential to improve symptoms, functional capacity, and biventricular hemodynamics. However, limitations to the anatomical substrate and size of the RVOT currently restrict PPVI eligibility to less than one-quarter of patients with RVOT dysfunction. The current review discusses contemporary practices in PPVI, evidence supporting the procedure, and future technologies and developments in the field.

Chagas Cardiomyopathy is Associated With Higher Incidence of Stroke: A Meta-analysis of Observational Studies

BACKGROUNDnChagas disease (CD) has been associated with an elevated risk of stroke, but current data are conflicting and prospective controlled studies are lacking. We performed a systematic review and meta-analysis examining the association between stroke and CD.nnnMETHODSnPubmed, Embase, Cochrane Central, Latin American database, and unpublished data were searched with the use of the following terms: (Chagas OR American trypanosomiasis) AND (dilated OR ischemic OR idiopathic OR nonChagasic OR stroke OR cerebrovascular). We included studies that reported prevalence or incidence of stroke in a CD group compared with a non-CD control group. Odds ratios (ORs) and their 95% confidence intervals (CIs) were computed with the use of a random-effects model.nnnRESULTSnA total of 8 studies and 4,158 patients were included, of whom 1,528 (36.7%) had CD. Risk of stroke was elevated in the group of patients with CD (OR 2.10, 95% CI 1.17-3.78). Similar results were observed in a subanalysis of cardiomyopathy patients (OR 1.74, 95% CI 1.02-3.00) and in sensitivity analysis with removal of each individual study. Furthermore, exclusion of studies at higher risk for bias also yielded consistent results (OR 1.70, 95% CI 1.06-2.71). Subanalysis restricted to studies that included patients with the indeterminate form found no significant difference in the stroke prevalence between CD and non-CD patients (OR 3.10, 95% CI 0.89-10.77).nnnCONCLUSIONSnCD is significantly associated with cerebrovascular events, particularly among patients with cardiomyopathy. These findings underline the need for prospective controlled studies in patients with Chagas cardiomyopathy to ascertain the prognostic significance of cerebrovascular events and to evaluate the role of therapeutic anticoagulation in primary prevention.

Prestenting for prevention of melody valve stent fractures: A systematic review and meta-analysis

The role of right ventricular outflow tract (RVOT) prestenting in the prevention of Melody valve stent fractures (SFs) is not well defined. We aimed to perform a systematic review and meta‐analysis comparing the incidence of SF in Melody valve transcatheter pulmonary implants with and without prestenting.

Device stratified comparison among transfemoral, transapical and transubclavian access for Transcatheter Aortic Valve Replacement (TAVR): A meta-analysis

a Department of Internal Medicine/Cardiology, University of Miami/Jackson Memorial Hospital, Miami, FL, United States b Department of Cardiology, Ochsner Medical Center, New Orleans, LA, United States c Department of Cardiology, Baylor College of Medicine, Houston, TX, United States d Department of Cardiology, Columbia College of Physicians and Surgeons, St. Lukes Hospital, New York, NY, United States

The Prevalence of Atrial Fibrillation and Conduction Abnormalities in Chagas' Disease: A Meta-Analysis.

Chagas’ disease (CD) has been associated with atrial fibrillation (AF) and electrocardiographic (ECG) conduction defects. However, prior studies have shown conflicting results. We performed a meta‐analysis comparing the prevalence of AF and conduction abnormalities between CD and non‐CD patients.

A META-ANALYSIS OF BIVALIRUDIN VERSUS ARGATROBAN FOR THE TREATMENT OF HEPARIN-INDUCED THROMBOCYTOPENIA

Introduction: Heparin-induced thrombocytopenia (HIT) is associated with significant thromboembolic risk and reported mortality of 20%. Currently, the only FDA approved therapy for HIT is argatroban. Bivalirudin has been suggested as an alternative anticoagulant for HIT. However, studies comparing

A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS ON VAGUS NERVE STIMULATION FOR THE HEART FAILURE MANAGEMENT

Background: Vagus nerve stimulation (VNS) acts by providing augmentation of parasympathetic tone with the theoretical effect of inhibiting progression of heart failure. We aimed to perform a meta-analysis comparing VNS with medical therapy for the management of heart failure with reduced ejection

PERCUTANEOUS EPICARDIAL MAPPING AND ABLATION OF VENTRICULAR TACHYCARDIA: A SYSTEMATIC REVIEW OF SAFETY OUTCOMES

Background: Safety outcomes of percutaneous epicardial ventricular tachycardia (VT) ablations vary widely in the literature. This is likely related to small sample sizes and heterogeneous patient and substrate characteristics between different studies. We aimed to perform a systematic review of

Catheter ablation as first-line in atrial fibrillation: is rhythm control finally better than rate control?

Atrial fibrillation (AF) is estimated to affect 3 million Americans and over 33 million individuals globally [1]. The individual and societal consequences of AF are severalfold, and include a higher risk of stroke, heart failure, dementia, hospitalizations, mortality, and impaired quality of life. The management of AF seeks to prevent thromboembolic events, improve survival, and minimize symptomatic burden through ventricular rate control or maintenance of sinus rhythm.