One-year Follow-up Outcomes Research Articles

Short-term efficacy of endovascular procedures for lower extremity thromboangiitis obliterans (Buerger’s disease)

ABSTRACT Purpose Although thrombolysis obliterans (TAO) has been recognized for more than a century, there is no optimal treatment for this disease. The aim of this report was to compare the short-term efficacies of catheter-directed thrombolysis (CDT), percutaneous transluminal angioplasty (PTA) and CDT+PTA in treating TAO disease. Method Consecutive patients with TAO treated at Ganzhou People’s Hospital between 2012 and 2022 were included in this retrospective study. According to the information provided in the medical records, endovascular procedures included CDT, PTA or CDT+PTA. One-year follow-up outcomes of the patients with TAO who underwent endovascular procedures were compared. The primary outcome was major adverse limb event (MALE) and the secondary outcomes were the technical success, complications, ABI at 1 week after surgery and minor amputation. Results Sixty-nine patients with TAO were assessed for inclusion in our single-center study from 2012 to 2022 and received endovascular procedures. Among them, 22 patients underwent CDT, 21 patients underwent PTA, and 26 patients underwent PTA+CDT. The one-year follow-up revealed significant differences in the MALE-free survival rates among the three groups, particularly between the CDT group and the PTA+CDT group (the hazard ratio (HR) for MALE-free survival was 0.173, 95% CI [0.050–0.599], p = 0.006). The technical success rates of the three groups were 63.6%, 90.5%, and 92.3%, respectively. There were differences in the ABI at one week after surgery among the three groups. Conclusions Endovascular procedures are effective for TAO in the short term. The effectiveness of CDT alone is suboptimal; combining CDT with PTA achieves the most favorable endovascular treatment outcome; while the effectiveness of PTA falls in between these two procedures.

Safety and Efficacy of Second-Generation Cryoballoon Ablation in Patients Aged over 75 Years

Objective: The use of second-generation cryoballoon (CB2) for pulmonary vein isolation (PVI) in atrial fibrillation (AF) ablation therapy is common. This study aimed to compare the safety and efficacy of CB2 ablation for PVI in AF patients aged 75 years and older to those under 75 years old. Methods: A retrospective, observational study was conducted, including AF patients who underwent CB2 for PVI between January 2018 and December 2020 at our center. The patients were divided into two groups based on age: those aged 75 years and older (elderly group) and those under 75 years (control group). Procedural characteristics, complications, and one-year follow-up outcomes were compared between the two groups using Student's t-test or the chi-square test for univariate analysis. Results: A total of 156 AF patients treated with CB2 for PVI were included in the study, with 78 patients aged 75 years and older (elderly group, mean age = 78 years) and 78 patients aged under 75 years (control group, mean age = 66 years). The PVI procedure duration was 86.2 ± 25.8 minutes for the elderly group and 83.2 ± 20.8 minutes for the control group (p = 0.413). The elderly group showed a higher trend of complications (8/78, 10.3%) compared to the control group (2/78, 2.6%) (p = 0.049), although no serious complications were observed. One-year follow-up revealed that approximately 80% of patients in both groups did not experience AF recurrence (p = 0.656). Conclusion: CB2 ablation for PVI appears to be safe and effective in AF patients aged 75 years and older, with outcomes comparable to those in younger patients. However, special attention should be given to venous puncture in elderly patients.

Prediction of subthalamic stimulation efficacy on isolated dystonia via support vector regression

IntroductionDeep brain stimulation (DBS) of subthalamic nucleus (STN) has been well-established and increasingly applied in patients with isolated dystonia. Nevertheless, the surgical efficacy varies among patients. This study aims to explore the factors affecting clinical outcomes of STN-DBS on isolated dystonia and establish a well-performed prediction model. MethodsIn this prospective study, thirty-two dystonia patients were recruited and received bilateral STN-DBS at our center. Their baseline characteristics and up to one-year follow-up outcomes were assessed. Implanted electrodes of each subject were reconstructed with their contact coordinates and activated volumes calculated. We explored correlations between distinct clinical characteristics and surgical efficacy. Those features were then trained for the model in outcome prediction via support vector regression (SVR) algorithm and testified through cross-validation. ResultsPatients demonstrated an average clinical improvement of 56 ± 25 % after STN-DBS, significantly affected by distinct symptom forms and activated volumes. The optimal targets and activated volumes were concentratedly located at the dorsal posterior region to STN. Most patients had a rapid response to STN-DBS, and their motor score improvement within one week was highly associated with long-term outcomes. The trained SVR model, contributed by distinct weights of features, could reach a maximum prediction accuracy with mean errors of 11 ± 7 %. ConclusionSTN-DBS demonstrated significant and rapid therapeutic effects in patients with isolated dystonia, by possibly affecting the pallidofugal fibers. Early improvement highly indicates the ultimate outcomes. SVR proves valid in outcome prediction. Patients with predominant phasic and generalized symptoms, shorter disease duration, and younger onset age may be more favorable to STN-DBS in the long run.

One-year clinical and radiologic outcomes of Surpass Evolve flow diverter for large unruptured intracranial aneurysms.

Surpass Evolve Flow Diverter (SE-FD; Stryker Neurovascular, Kalamazoo, MI, USA) was launched in 2019 as a new generation FD of Surpass Streamline. The aim of this study was to report the effectiveness and safety of SE-FD insertion for unruptured intracranial aneurysm at one-year follow-up. Between November 2019 and October 2021, a total of 106 patients with 108 aneurysms were treated with FD in single institution. Of these, SE-FD insertion was performed in 40 patients with 41 aneurysms. At one-year follow-up, clinical and angiographic outcomes were retrospectively evaluated from electronic medical record and aneurysm database. There were 12 male and 28 female patients (mean age 59.1 years, 95% CI: 55.3-62.9). Fusiform aneurysm dissection was 46.3% (19/41). Mean maximum aneurysm diameter was 13.2 mm (SD 5.53), and 34.1% (14/41) of aneurysms were 15 mm or bigger. Among 41 aneurysms, complex aneurysm (recurred, thrombosed, or branch artery-incorporated) was accounted for 41.5% (17/41). All procedures were successfully conducted with 7.3% (3/41) of procedure-related complications. At one-year follow-up (N.=40), neurologic morbidity was noted in 2 cases (5.0%; both with modified Rankin Scale [mRS] 1) without any mortality. At one-year follow-up (N.=41), radiologic outcomes were adequate occlusion in 33 (80.5%) and complete occlusion in 29 (70.7%). There was no retreatment in our cohort. Surpass Evolve Flow Diverter seemed to be safe and effective for the treatment of dissecting/fusiform or complex aneurysms at one-year follow-up. However, further study is needed to evaluate long term results.

Outcomes of diabetic patients with acute coronary syndromes treated with aspirin in primary prevention

Abstract Introduction The use of aspirin in primary prevention (PP) remains a matter of international debate. In type 2 diabetes mellitus (DM2) patients with high/very high cardiovascular (CV) risk, low dose aspirin may be considered for PP (class IIb, evidence level A) in european guidelines in the absence of hemorrhagic contraindication. Objectives Our aim was to analyze in-hospital and one year follow-up (FU) outcomes of acute coronary syndrome (ACS) DM2 patients without previous atherosclerotic CV disease (ASCVD) treated with vs without aspirin in primary prevention. Methods A retrospective analysis was carried out of DM2 patients without established ASCVD admitted with ACS included in the Portuguese Registry of ACS between 2010-2021. Patients were divided in two groups regarding the use of aspirin in primary prevention (with-AG and without-NAG). Composite primary outcome (re-infarction, heart failure, shock, death – in-hospital) and secondary outcomes (one-year all-cause mortality and mortality/rehospitalization) were compared in both groups. Independent predictors of primary outcome were assessed by multivariate logistic regression. Survival analysis and cox regression were used to compare and identify predictors of secondary outcomes. P value < 0.05 indicates statistical significance. Results A total of 4517 patients were analyzed, mean age 68±12 years, 64.8% male. AG showed higher rates of hypertension (89.9%, p<0.001), dyslipidemia (74.1%, p<0.001), history of heart failure (9.2%, p<0.001), valvular disease (3.9%, p=0.002) and chronic renal disease (12.3%, p<0.001). STEMI presentation was more frequent in NAG (48%, p<0.001). Multivessel disease (mainly three vessels disease) was more frequent in AG (32.7%, p<0.001), but anterior descendent (AD) as culprit artery was more common in NAG (40.3%, p=0.013). Both groups had no difference in major hemorrhage occurrence. Primary outcome was more frequent in AG (18.6%, p=0.034). One-year all-cause mortality and mortality/rehospitalization were higher in AG (9.90%, p=0.004 and 32.9%, p=0.017, survival analysis). Independent predictors of primary outcome were aspirin in primary prevention (OR 1.38, p=0.026), age (OR 1.59, p<0.001), valvular disease (OR 4.46, p<0.001), STEMI at presentation (OR 2.20, p<0.001), LVEF <40% (OR 4.40, p<0.001) and Killip-Kimball class > I (OR 12.9, p<0.001). Aspirin in primary prevention (HR 1.84, p=0.004), chronic lung disease (HR 5.68, p<0.001), and Killip-Kimball class > I (HR 3.27, p<0.001) were predictors of one-year all-cause mortality. Conclusion DM2 patients with ACS treated with aspirin in primary prevention had worst in-hospital and one-year FU outcomes. Although with higher rates of three vessels disease, PP with aspirin showed less AD disease and STEMI presentation, with similar major clinical hemorrhage.

Abstract 12153: Prevalence and Prognostic Implications of Worsening Renal Function After Acute Myocardial Infarction

Introduction: Limited data exist on the association between longitudinal changes in renal function and long-term clinical outcomes in patients who survive acute myocardial infarction (AMI) events. Hypothesis: We sought to investigate the relationship between worsening renal function (WRF) at one-year follow-up and clinical outcomes at three years after AMI. Methods: We analyzed data from 13,104 patients enrolled in the national AMI registry from November 2011 to December 2015. Patients with all-cause death, recurrent myocardial infarction (re-MI), and re-hospitalization for heart failure (rHHF) at one-year follow-up after AMI were excluded. A total of 6,235 patients were extracted and divided into WRF and non-WRF groups. WRF was defined as a ≥25% decrease in estimated glomerular filtration rate (eGFR) from baseline to one-year follow-up. The primary outcome was three-year major adverse cardiac events (MACE), a composite of all-cause death, re-MI, and rHHF. Results: On average, a -1.5 ml/min/1.73 m 2 /year rate of decline in eGFR was exhibited, and 575 (9.2%) patients exhibited WRF at one-year follow-up. After multiple adjustments, WRF at one-year follow-up was independently associated with increased risks of MACEs (adjusted hazard ratio: 1.498, 95% confidence interval: 1.113-2.016, P =0.01), all-cause death, and re-MI at three-year follow-up (Figure 1). Older age, female, diabetes, hypertension, non-ST segment elevation AMI, anterior AMI, anemia, left ventricular ejection fraction <35%, and baseline eGFR <30 ml/min/1.73 m 2 were identified as independent predictors of WRF after AMI. Conclusions: WRF at one-year follow-up after AMI intuitively seems like a risk marker indicating multiple comorbidities. Monitoring serum creatinine in patients at one-year follow-up after AMI may help to identify those who are at the highest risk and guide effective long-term therapeutics.

Pretreatment antithrombotic strategies in non-ST elevation acute coronary syndromes in contemporaneous clinical practice

BackgroundPretreatment antithrombotic strategies in non-ST elevation acute coronary syndromes (NSTE-ACS) during hospitalization is still a matter of contention within the cardiology community. Our aim was to analyze in-hospital and one-year follow-up outcomes of patients with NSTE-ACS pretreated with dual antiplatelet therapy (DAPT) versus single antiplatelet therapy (SAPT). MethodsA retrospective study was carried out with NSTE-ACS patients who planned to undergo an invasive strategy and were included in the Portuguese Registry of ACS between 2018 and 2021. A composite primary outcome (in-hospital re-infarction, stroke, heart failure, hemorrhage, death) was compared regarding antiplatelet strategy (DAPT versus SAPT). Secondary outcomes were defined as one-year all-cause mortality and one-year cardiovascular rehospitalization. ResultsA total of 1469 patients were included, with a mean age of 66 ± 12 years, and 73.9 % were male. The DAPT regime was used in 38.2 % of patients and SAPT in 61.8 % of patients. NSTE myocardial infarction was the most frequent presentation (88.5 %). Revascularization was performed within 24 h in 55.2% of patients. Time until revascularization >24 h occurred in 44.8% of patients, with 16.5% of these between [24 h–48 h], 10.6% in [48 h–72 h] and 17.6% > 72 h. The primary outcome was more frequently observed in the SAPT group (10.4 %, p = 0.033), mainly driven by more ischemic events. Time until revascularization >72 h and the SAPT regime were independent predictors of the primary outcome (OR 3.09, p = 0.005, and OR 2.03, p = 0.008, respectively). ConclusionNSTE-ACS patients pretreated with SAPT had worse in-hospital outcomes. This difference can probably be explained by time until revascularization delay.

Effectiveness and Safety of Same-Day Discharge After Left Atrial Appendage Closure Using Moderate Conscious Sedation: One-Year Follow-Up Outcomes

Effectiveness and Safety of Same-Day Discharge After Left Atrial Appendage Closure Using Moderate Conscious Sedation: One-Year Follow-Up Outcomes

Feasibility of Same-Day Discharge Approach After Transcatheter Mitral Valve Repair Procedures: One-Year Follow-Up Outcomes

Feasibility of Same-Day Discharge Approach After Transcatheter Mitral Valve Repair Procedures: One-Year Follow-Up Outcomes

CRT-700.31 Effectiveness and Safety of Same-Day Discharge After Left Atrial Appendage Closure Using Moderate Conscious Sedation: One-Year Follow-Up Outcomes

CRT-700.31 Effectiveness and Safety of Same-Day Discharge After Left Atrial Appendage Closure Using Moderate Conscious Sedation: One-Year Follow-Up Outcomes

Optical coherence tomography classifications of diabetic macular edema and response to aflibercept: One-year follow-up outcomes in a Chinese population.

To evaluate the effect of intravitreal aflibercept on different classifications of diabetic macular edema (DME) by spectral-domain optical coherence tomography. This hospital-based retrospective study included 95 consecutive patients (130 eyes) diagnosed with DME. Three groups were defined: diffuse retinal thickening (DRT), cystoid macular edema and serous retinal detachment. All eyes received intravitreal aflibercept (0.05 mL/2 mg) 5 times monthly. Best corrected visual acuity (BCVA) in (logarithm of the minimum angle of resolution) units and central macular thickness (CMT) on optical coherence tomography were recorded at months 1, 2, 3, 4, 6, and 12 after the injections. There was no significant baseline difference in BCVA (P = .273) or CMT (P = .115) among the 3 groups. Over 12 months, the BCVA of the DRT group significantly improved from baseline (P = .013). The BCVA of the cystoid macular edema (P = .062) and serous retinal detachment groups (P = .073) improved slightly from baseline. The DRT group had the greatest BCVA improvement (P = .021). Over 12 months, the CMTs of all 3 groups significantly decreased from baseline (P = .016, P = .025, P = .031). The CMT decreased more in the DRT group than in the other 2 groups (P = .009). The CMT changes were most evident in the DRT group (P = .022). Binary logistic regression analysis showed that DME type, disorganization of the retinal inner layers, ellipsoid zone disruption and external limiting membrane disruption independently predicted the effect of aflibercept treatment in DME patients (P = .006, P = .001, P = .004, P = .001). Aflibercept therapy improved anatomical structure and visual acuity in every type of DME; DRT responded best in terms of both BCVA and CMT. Furthermore, DME, disorganization of the retinal inner layers, external limiting membrane disruption and ellipsoid zone disruption independently predicted the effect of aflibercept treatment in DME patients.

Medial patellofemoral ligament reconstruction using superficial layer of quadriceps tendon autograft: A case series of three patients

IntroductionRecurrent patellar dislocation which caused by Medial Patellofemoral Ligament (MPFL) injury could be treated by MPFL reconstruction. This study evaluated MPFL reconstruction using superficial layer of quadriceps tendon autograft with knee functional outcome. MethodThree patients with recurrent patellar dislocation underwent MPFL reconstruction with superficial layer of quadriceps tendon autograft. The central quadriceps tendon was harvested at the superficial layer of the tendon. Then the proximal autograft routed medially on the periosteal hinge through vastus medial muscle. Functional outcome using IKDC, Tegner-Lysholm, and Modified Cincinnati were assessed pre and post-operative. ResultA good stability and painless knees were achieved. IKDC score, Tegner-Lysholm, and Modified Cincinnati was improved from pre-operative to post-operative. No severe postoperative complication was recorded. DiscussionThe superficial layer of quadriceps tendon has similar biomechanical and anatomical macroscopic attribute to native MPFL. The procedure using quadriceps tendon was simple and has fewer complication than using other autografts, such as hamstring tendon, adductor tendon, and patellar tendon. The one-year follow-up outcome of this procedure is excellent. ConclusionMPFL reconstruction with superficial layer of quadriceps tendon autograft was proven to prevent patellar dislocation without deteriorating quadriceps muscle strength and produced knee stabilization with functional score improvement.

Impact of Total Ischemic Time on Clinical Outcomes in Patients With ST-Elevation Myocardial Infarction: Lost Time Is Never Found Again.

IntroductionA dedicated relationship between total ischemic time (TIT) and clinical outcomes has been reported in ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI); however, this claim is yet to be clarified. Accordingly, this study was carried out to determine the association of TIT with in-hospital and one-year follow-up outcomes in STEMI patients undergoing primary PCI.Material and methodologyBetween December 2020 and December 2021, a total of 113 consecutive STEMI patients undergoing primary PCI were prospectively included. According to TIT, all patients were categorized into two groups: (a) shorter TIT (<180 minutes) and (b) prolonged TIT (≥180 minutes). Data regarding baseline, clinical, and angiographic characteristics, as well as in-hospital and one-year follow-up outcomes were noted among the two groups.ResultsA total of 113 STEMI patients with a mean age of 69.3 ± 13.6 years were studied, and males [92 (81.4%)] were predominately affected with STEMI. A median TIT was 348 minutes. Of 113, 30 (23.0%) patients had a TIT of <180 minutes and 83 (73.5%) had a TIT of ≥180 minutes. Prolonged ischemia duration was significantly associated with composite of death, rehospitalization, and revascularization (p=0.02) at one-year follow-up.ConclusionTIT can be considered a good quality indicator, together with door-to-balloon time and other clinical determinants, in order to improve survival in STEMI patients.

Visual outcomes of photorefractive keratectomy in non-children with anisometropic amblyopia: One-year Follow-up Outcomes.

To evaluate the safety, efficiency, short term stability, and sensory results of photorefractive keratectomy (PRK) in anisometropic in non-compliant children with correction. Twelve eyes of 12 children with an age range: 6-17 years and anisometropic amblyopia who underwent PRK under general anesthesia to correct the dioptric difference between the eyes were included in this study. A complete ophthalmic assessment including refractive status, uncorrected and corrected distance visual acuity (UDVA & CDVA), and binocular vision status using the Worth 4-dot test and stereopsis were performed before and 1, 3, 6, and 12 months after PRK. The mean preoperative CDVA was 0.34 ± 0.24 LogMAR which showed a statistically significant improvement at 12 months (0.20 ± 0.19, p = 0.024) after surgery compared to the preoperative assessment. (p = 0.003) The mean preoperative UDVA was 0.63 ± 0.24 LogMAR that increased to 0.44 ± 0.24, 0.32 ± 0.16, 0.25 ± 0.19, and 0.25 ± 0.19 LogMAR at 1, 3, 6, and 12 months after PRK, respectively. One to three lines improvement in UDVA and CDVA was seen in 10 (83.4%) and 8 eyes (66.7%); while one line UDVA and CDVA loss was seen in one (8.3%) and one (8.3%) eye and unchanged UDVA and CDVA was seen in 1 (8.3%) and 3 eyes (25%), respectively. The mean preoperative stereoacuity was 341.9 ± 245.7 s of arc, which significantly improved to 166.6 ± 87.5 s of arc 12 months after PRK. (p = 0.012). PRK was an effective surgical alternative to improve visual acuity and stereopsis in anisometropic children who did not cooperate with conventional methods of amblyopia therapy.

P386 Predictive models for assessing the response to ustekinumab in Crohn’s disease patients

Abstract Background The loss of response to biologics remains a clinical challenge for which the discovery of predictive factors is helpful. In this direction, exploiting tree-based models on top of logistic regression (LR) allows to uncover unexpected valuable predictors. The aim of the study is to develop performant predictions of ustekinumab (USK) response at one year of follow-up in a cohort of Crohn’s disease (CD) patients using benchmark logistic regression (LR) and tailored tree-based techniques, Random forest (RF) and Gradient Boosting Decision Trees (GBDT). Methods This is a retrospective study based on a cohort of, 80 CD patients treated with USK. Inputs include demographic data, disease characteristics as well as pharmacokinetics, clinical and biological parameters at baseline, week, 8 and, 16. After one-year follow-up, both clinical outcome (achieved in case of USK maintenance without optimization, n=80) and endoscopic outcome (achieved in case of SES-CD&amp;lt;10, n=52) are evaluated. The inputs are firstly ranked via the p-values for LR method and the impurity criterion for the tree-based ensemble methods. Then, the optimal subset of inputs for both methods is selected following a sequential feature selection. Due to the limited size cohort, a nested cross-validation framework was applied to avoid bias and overfitting. The performance of the final models is evaluated using the area under the ROC curve (AUC) with standard deviation (SD), sensitivity (Se) and specificity (Sp). All the analyses are performed with Python, 3.6, 6 using the packages statsmodels and Scikit-learn. Results Input data characterizing the CD cohort are presented in Table, 1. At one-year follow-up, clinical and endoscopic outcomes were achieved in, 56.2% (n=45/80) and, 69% (n=, 36/52), respectively. Table, 2 summarizes the predictive model characteristics at the different timepoints. Whatever the outcome, predictive models exhibited an increased accuracy over the induction timepoints. At week, 16, a multivariate LR allowed to predict endoscopic outcome with an AUC, 0.86±0.12, Se, 83% and Sp, 70%. The explanatory variables were CRP level at week, 8 and, 16, lymphocyte count at week, 8 and USK trough levels at week, 16. The best model to predict endoscopic outcome was obtained by RF with an AUC of, 0.92 ±0.08, Se, 91% and Sp, 75%. The key inputs were lymphocyte count at baseline. Conclusion This study highlighted the added value of applying tree-based models for the development of accurate predictive models. More specifically, the evolution of biological markers during induction as well as USK trough levels at week, 16 are relevant factors to predict endoscopic outcome among CD patients treated with USK

Cutting Balloon Combined with Drug-Coated Balloon Angioplasty for the Treatment of In-Stent Restenosis.

Drug-coated balloon (DCB) has emerged as an alternative therapeutic choice for in-stent restenosis (ISR) lesions. Cutting balloon angioplasty (CBA) is also a strategy utilized to treat tight stenotic lesions or ISR lesions. Few studies have focused on whether CBA plus DCB could achieve a better result in lowering the incidence of recurrent ISR. This study aimed to evaluate the efficacy of CBA plus DCB for ISR lesions.Between August 2011 and December 2017, 681 patients (937 lesions) were diagnosed with ISR and treated with DCBs in our hospital. The CBA plus DCB group comprised 90 patients who underwent PCI with further CBA plus DCB, and the DCB alone group comprised 591 patients who underwent percutaneous coronary intervention (PCI) with DCB alone.Baseline characteristics, the types of previous stents, lesion type, prevalence of ostial lesion and left main lesion, and pre-PCI and post-PCI stenotic percentage showed no significant difference between the two groups. Only post-PCI reference luminal diameter and size of DCB were larger in the CBA plus DCB group. During the one-year follow-up period, late loss and clinical outcomes did not differ between the two groups before and after propensity score matching. The incidence of subtotal/total occlusion with delay flow was lower in the CBA plus DCB group after propensity score matching (4.1% versus 10.9%; P = 0.030).In these patients with ISR lesions, the clinical outcomes and the incidence of repeat target lesion revascularization were similar after treatment with CBA plus DCB versus DCB alone. Further study is warranted, including prospective, randomized comparisons.

Impact of Periodontal Attachment Loss on the Outcome of Endodontic Microsurgery: A Systematic Review and Meta-Analysis

Background and Objectives: Endodontic microsurgery (EMS) aims to eradicate the sources of infection once the apical root resection removes most of the infected anatomical structures and repairs potential procedural errors in the apical region. An endodontic-periodontal lesion yields a pathological communication between the pulp and the periodontium. The purpose of this systematic review and meta-analysis is to evaluate the impact of periodontal attachment loss on the outcome of teeth submitted to EMS. Materials and Methods: PRISMA guidelines were followed. An electronic search was performed in EBSCOhost, Embase and PubMed databases with the following search key: (“endodontic microsurgery” AND “outcome”). No filters were used concerning the year of publication or language. Only randomized clinical trials, prospective and retrospective clinical studies in humans, with a minimum one-year follow-up, defined clinical and radiographic outcome criteria and estimable success rate for endodontic-periodontal lesion were included. Statistical analysis was performed using OpenMeta[Analyst] software. Results: Of a total of 113 articles, 34 were selected for full-text reading after duplicates deletion and title and abstract analysis. Thirteen and six studies were included in the systematic review and meta-analysis, respectively. A total of 2775 pooled teeth were submitted to EMS, of which 492 teeth and 4 roots had periodontal involvement. According to the qualitative analysis, success rates of the endodontic-periodontal group ranged from 67.6% to 88.2%. Meta-analysis revealed that the absence of periodontal attachment loss was predictive of a higher likelihood of success with an odds ratio of 3.14. Conclusions: Periodontal attachment loss presents a risk factor for EMS outcome. Although endodontic-periodontal lesions were associated with lower success rates considering a 1 to 10 years follow-up period, long-term successful prognosis following EMS has been reported, therefore presenting a fully valid and viable therapeutic option for the management of this type of lesions.

Impact of atrial fibrillation pattern on outcomes after left atrial appendage closure: lessons from the prospective LAARGE registry

BackgroundNon-paroxysmal (NPAF) forms of atrial fibrillation (AF) have been reported to be associated with an increased risk for systemic embolism or death.MethodsComparison of procedural details and long-term outcomes in patients (pts) with paroxysmal AF (PAF) against controls with NPAF in the prospective, multicentre observational registry of patients undergoing LAAC (LAARGE).ResultsA total of 638 pts (PAF 274 pts, NPAF 364 pts) were enrolled. In both groups, a history of PVI was rare (4.0% vs 1.6%, p = 0.066). The total CHA2DS2-VASc score was lower in the PAF group (4.4 ± 1.5 vs 4.6 ± 1.5, p = 0.033), while HAS-BLED score (3.8 ± 1.1 vs 3.9 ± 1.1, p = 0.40) was comparable. The rate of successful implantation was equally high (97.4% vs 97.8%, p = 0.77). In the three-month echo follow-up, LA thrombi (2.1% vs 7.3%, p = 0.12) and peridevice leak > 5 mm (0.0% vs 7.1%, p = 0.53) were numerically higher in the NPAF group. Overall, in-hospital complications occurred in 15.0% of the PAF cohort and 10.7% of the NPAF cohort (p = 0.12). In the one-year follow-up, unadjusted mortality (8.4% vs 14.0%, p = 0.039) and combined outcome of death, stroke and systemic embolism (8.8% vs 15.1%, p = 0.022) were significantly higher in the NPAF cohort. After adjusting for CHA2DS2-VASc and previous bleeding, NPAF was associated with increased death/stroke/systemic embolism (HR 1.67, 95% CI 1.02–2.72, p = 0.041).ConclusionAtrial fibrillation type did not impair periprocedural safety or in-hospital MACE patients undergoing LAAC. However, after one year, NPAF was associated with higher mortality.Graphic abstract

Impact of atrial fibrillation pattern on left atrial appendage closure: insights from the prospective LAARGE registry

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Stiftung für Herzinfarkforschung Background Non-paroxysmal (NPAF) forms of atrial fibrillation (AF) have been reported to be associated with an increased risk for systemic embolism or death compared with paroxysmal AF (PAF). This study investigates the procedural safety and long-term outcomes of left atrial appendage closure (LAAC) in patients with different forms of AF. Methods Comparison of procedural details and long-term outcomes in patients (pts) with PAF against controls with NPAF in the prospective, multicentre observational registry of patients undergoing LAAC in Germany (LAARGE). Results A total of 638 pts (PAF 274 pts, NPAF 364 pts) were enrolled. NPAF consisted of 31.6% patients with persistent AF and 68.4% with longstanding persistent AF or permanent AF. In both groups, a history of PVI was rare (4.0% vs 1.6%, p = 0.066). The PAF group had significantly less history of heart failure (19.0% vs 33.0%, p &amp;lt; 0.001) while the current median LVEF was similar (60% vs 60%, p = 0.26). The total CHA2DS2-VASc score was lower in the PAF group (4.4 ± 1.5 vs 4.6 ± 1.5, p = 0.033), but no difference in the HAS-BLED score (3.8 ± 1.1 vs 3.9 ± 1.1, p = 0.40) was observed. The rate of successful implantation was equally high (97.4% vs 97.8%, p = 0.77) in both groups. In the three-month echo follow-up, device-related thrombi (2.1% vs 7.3%, p = 0.12) and peridevice leak &amp;gt;5 mm (0.0% vs 7.1%, p= 0.53) were numerically higher in the NPAF group. Overall, in-hospital complications occurred in 15.0% of the PAF cohort and 10.7% of the NPAF cohort (p = 0.12). In the one-year follow-up, unadjusted mortality (8.4% vs 14.0%, p = 0.039) and combined outcome of death, stroke and systemic embolism (8.8% vs 15.1%, p = 0.022) were significantly higher in the NPAF cohort. After adjusting for CHA2DS2-VASc and previous bleeding, NPAF was associated with increased death/stroke/systemic embolism (HR 1.67, 95%-CI: 1.02-2.72). Conclusion Atrial fibrillation type did not impair periprocedural safety or in-hospital MACE of patients undergoing LAAC. However, after one year, NPAF was associated with higher mortality and combined outcome of death, stroke and systemic embolism.

Comparison of the Outcomes between Coronary No-Reflow and Slow-Flow Phenomenon in Non-STEMI Patients.

ResumoFundamento:Os fenômenos de slow-flow (CSFP) e no-reflow coronariano (CNP) estão associados a um risco aumentado de eventos cardiovasculares adversos maiores (ECAM).Objetivos:Este estudo teve como objetivo avaliar e comparar os resultados do seguimento clínico de um ano entre pacientes com CNP e CSFP submetidos a intervenções coronárias percutâneas (ICP) em infarto agudo do miocárdio sem supradesnivelamento do segmento ST (IAMSSST).Métodos:Este estudo incluiu um total de 858 pacientes com diagnóstico de IAMSSST e submetidos a ICP nas 24 horas desde o início dos sintomas. Os pacientes foram divididos em dois grupos, o grupo CSFP (n = 221) e o grupo CNP (n = 25), considerando as características angiográficas do fluxo da trombólise no infarto do miocárdio (TIMI) e na artéria relacionada ao infarto. Os pacientes tiveram um seguimento de um ano. Um valor de p <0,05 foi considerado significativo.Resultados:O CNP foi observado em 2,91% e o CSFP em 25,75% dos pacientes. Os desfechos clínicos analisaram que a incidência de acidente vascular cerebral (AVC) foi significativamente maior no grupo CNP do que no grupo CSFP (6 (24%) vs. 6 (2,70%), p <0,001) e a de ECAM foi significativamente maior no grupo CNP do que no grupo CSFP (11 (44%) vs. 51 (23,10%), p = 0,022). A análise de regressão logística condicional forward demonstrou que o índice de massa corporal (IMC) (OR = 1,11, IC95%: 1,00-1,24, p = 0,038) e frequência cardíaca (FC) basal (OR = 0,923, IC 95%: 0,88-0,96, p <0,001) foram os preditores independentes de CNP no IAMSSST.Conclusões:Pacientes com CNP têm piores resultados clínicos e um maior risco de AVC em comparação com pacientes com CSFP no IAMSSST.