Sukhchain Singh

Prevalence of simultaneously measured interarm systolic blood pressure difference and its clinical and demographic predictors: a systemic review and meta-analysis.

Prevalence of interarm systolic blood pressure difference and clinical and demographic characteristics associated with interarm systolic blood pressure difference (IASBPD) have been a matter of debate. We aimed to ascertain the prevalence of IASBPD and clinical and demographic characteristics associated with it. We searched PubMed, EMBASE, and CINAHL, Ovid and Cochrane Library, and Google Scholar. Twenty-seven studies meeting all inclusion criteria were included in the analysis. Weighted average cumulative prevalence of simultaneous IASBPD of 10, 15, and 20 mmHg or greater was 9.49% [95% confidence interval (CI) 7.9–11.1%], 5.3% (95% CI 3.1–7.5%), and 4.4% (95% CI 1.5–7.4%), respectively. The prevalence of IASBPD of 10 mmHg was 9% (95% CI 7–11%), 7.5% (95% CI 5.6–9.4%), and 12.1% (95% CI 8.2–16.1%) in outpatient, community, and hospital-based setting, respectively. The prevalence of IASBPD of 15 mmHg was 4.9% (95% CI 2.7–7.2%) in outpatient and 8% in hospital setting. The prevalence of IASBPD of 20 mmHg was 4.4% (95% CI 2.8–11.6%) in outpatient and 4.4% (95% CI 2.1–6.8%) for the hospital setting. Pairwise meta-analysis of five studies showed that the presence or absence of IASBP was not associated with age, sex, diabetes, hypertension, dyslipidemia, and smoking history. However, participants with IASBPD of 10 mmHg or greater had a higher BMI compared with those with IASBPD of less than 10 mmHg. After BMI, hypertension and dyslipidemia had strongest association with IASBPD, but results were not statistically significant. IASBPD is relatively prevalent, but prevalence is lower than that previously reported. Prevalence is higher when blood pressure is measured in hospital setting compared with outpatient and community setting.

Efficacy of Various Percutaneous Interventions for In-Stent Restenosis Comprehensive Network Meta-Analysis of Randomized Controlled Trials

Background—In-stent restenosis (ISR) remains a difficult problem in interventional cardiology. The relative efficacy and safety of available interventions is not clear. We aimed to perform a network meta-analysis using both direct evidence and indirect evidence to compare all available interventions. Methods and Results—We systematically searched electronic databases for randomized trials comparing ≥2 treatments for ISR. A network meta-analysis was performed using a Bayesian approach. Eleven treatments were compared in 31 studies with 8157 patient-years follow-up. Compared with balloon angioplasty, everolimus-eluting stent (hazard ratio [95% credibility interval], 0.13 [0.048–0.35]), paclitaxel-eluting balloon (0.32 [0.20–0.49]), paclitaxel-eluting cutting balloon (0.054 [0.0017–0.5]), paclitaxel-eluting stent (0.39 [0.24–0.62]), and sirolimus-eluting stent (0.32 [0.18–0.50]) are associated with lower target vessel revascularization. Balloon angioplasty is not different from cutting balloon (0.73 [0.31–1.5]), excimer laser (0.89 [0.29–2.7]), rotational atherectomy (0.96 [0.53–1.7]), and vascular brachytherapy (0.60 [0.35–1.0]). In drug-eluting stent ISR, balloon angioplasty was inferior to everolimus-eluting stent (0.19 [0.049–0.76]), paclitaxel-eluting balloon (0.43 [0.18–0.80]), paclitaxel-eluting stent (0.35 [0.13–0.76]), and sirolimus-eluting stent (0.36 [0.11–0.86]) for target vessel revascularization. There was no difference between treatments in probable or definitive stent thrombosis. The results of binary restenosis and target lesion revascularization were similar. Paclitaxel-eluting cutting balloon, everolimus-eluting stent, and paclitaxel-eluting balloon have the highest probability of being in the top 3 treatments based on low target lesion revascularization, but there was no statistical significant difference between them. Conclusions—Balloon angioplasty is inferior to all drug-eluting treatments for ISR, including drug-eluting stent ISR. Drug-eluting stent, particularly everolimus-eluting stent, or paclitaxel-eluting cutting balloon and paclitaxel-eluting balloon should be preferred for treating ISR.

Comparative Efficacy and Safety of Prasugrel, Ticagrelor, and Standard-Dose and High-Dose Clopidogrel in Patients Undergoing Percutaneous Coronary Intervention: A Network Meta-analysis.

Authors aimed to compare efficacy and safety of prasugrel, ticagrelor, and standard-dose (SD) and high-dose (HD) clopidogrel in patients undergoing percutaneous coronary intervention (PCI). PubMed, EMBASE, CENTRAL, and clinicaltrials.gov were searched for studies comparing prasugrel, ticagrelor, SD and HD clopidogrel in patients undergoing PCI. Frequentist and Bayesian network meta-analyses were performed besides direct pairwise comparisons. Thirty trials, comprising 34,563 person-year data, were included. Prasugrel emerged as a best drug to prevent definite or probable stent thrombosis, followed by HD clopidogrel and ticagrelor, with SD clopidogrel being the worst. Myocardial infarction was least likely to be prevented by SD clopidogrel after PCI, and remaining 3 were superior to it with little difference among them. SD clopidogrel was least effective in preventing cardiovascular deaths after PCI. Prasugrel was most effective in preventing cardiovascular deaths, although having only small advantage over ticagrelor and HD clopidogrel. Ticagrelor reduced all-cause mortality by a small margin compared with rest of treatments. SD clopidogrel, followed by ticagrelor, resulted in significantly lower thrombolysis in myocardial infarction major bleeding complications compared with prasugrel. Analysis of any bleeding revealed similar trend. HD clopidogrel performed better than prasugrel in terms of bleeding complications. In conclusion, Prasugrel is likely most effective drug to prevent post-PCI ischemic events but at the expense of higher bleeding. Ticagrelor followed by HD clopidogrel seems to strike the right balance between efficacy and safety. HD clopidogrel can be considered as an alternative to newer P2Y12 inhibitors.

Effect of Cocaine on Coronary Microvasculature

According to the Drug Abuse Warning Network [(1)][1], cocaine is the number 1 illicit drug resulting in most emergency room visits and hospitalizations and is rapidly growing in urban settings. Many patients undergoing coronary angiography may even demonstrate normal epicardial coronaries (EpC).