Random-effects Model Research Articles

Survival and Treatment Outcomes in Gastric Cancer Patients with Brain Metastases: A Systematic Review and Meta-Analysis

Background: Brain metastases (BM) from gastric cancer (GC) are rare but associated with poor prognosis, significantly impacting patient survival and quality of life. The objective of this systematic review and meta-analysis is to consolidate existing research on BM from GC, evaluate the incidence and clinical outcomes, and explore the effectiveness of treatment options. Methods: A systematic search was conducted across the Medline, Web of Science, and Scopus databases, following PRISMA guidelines. Eighteen high-quality studies, as per the Newcastle–Ottawa Quality Assessment Scale, were included, encompassing 70,237 GC patients, of whom 621 developed BM. Data on progression-free survival (PFS), overall survival (OS), neurological symptoms, and HER2 status were analyzed using a random-effects model. Results: The incidence of BM in GC patients was found to be 2.29% (95% CI: 1.06–3.53%), with the range extending from 0.47% to 7.79% across studies. HER2-positive status was significantly associated with a higher likelihood of developing BM, with an odds ratio of 43.24 (95% CI: 2.05–913.39; p = 0.02), although this finding was based on limited data. The surgical resection of BM was linked to significantly improved survival outcomes, with a mean difference in OS of 12.39 months (95% CI: 2.03–22.75; p = 0.02) compared to non-surgical approaches. Conclusions: The surgical resection of brain metastases in GC patients significantly enhances overall survival, while HER2-positive patients may show a higher risk for developing BM. These findings underscore the importance of tailored therapeutic approaches for GC patients with BM.

Building Financial Wellness: Randomized Controlled Trial of a Financial Education and Support Intervention.

Many people receiving services for psychiatric disorders live on low incomes, navigate complex financial situations, and have limited economic security. The authors sought to determine whether a financial wellness intervention delivered virtually by peers would increase financial literacy, reduce economic strain, and improve financial competency. One hundred participants receiving services for psychiatric disorders were recruited from community programs and via social media and were randomly assigned (1:1) to receive either an intervention called Building Financial Wellness (N=51) or services as usual (N=49). The intervention involved six virtual 1.5-hour group sessions, followed by three virtual one-on-one booster sessions. Outcomes were assessed with the Consumer Financial Protection Bureau's Financial Well-Being Scale (primary), Financial Strain Questionnaire, Financial Capability Scale, and Financial Self-Sufficiency Scale. Knowledge regarding money management was measured with a financial literacy assessment based on class content. Intent-to-treat longitudinal multivariable analysis included random-effects linear and logistic regression models. Overall, 86% of the study participants either lived in poverty (46%) or met the federal definition of low income (40%). Participants assigned to the intervention had greater improvement over time in financial well-being, capability, strain, self-sufficiency, and literacy. Satisfaction with the intervention was high. Reports from participants receiving booster sessions indicated that ongoing support facilitated their achievement of longer-term financial goals. Provision of financial education and support improved monetary well-being, competence, and literacy. With poverty long considered to be an intractable problem associated with psychiatric disorders, peer-taught financial education focused on financial wellness can help people acquire money management skills and manage economic stressors.

Reducing ACL injury risk: A meta-analysis of prevention programme effectiveness.

The aim of this study was to conduct a meta-analysis of the literature regarding anterior cruciate ligament (ACL) injury prevention programmes (IPPs) in order to assess the effectiveness of ACL prevention programmes based on current high-quality studies. The hypothesis was that the implementation of ACL IPPs significantly reduces the incidence of ACL ruptures compared to standard practice. A meta-analysis of the literature was conducted using the databases PubMed, EMBASE, MEDLINE, CINHAL and Cochrane Central Register of Controlled Trials. The search terms utilized were ACL, injury, knee, control and prevention. The collected data and reported clinical outcomes were independently gathered by three different individuals. After evaluating the heterogeneity of the studies, the DerSimonian-Laird random effects models were employed to determine the pooled risk ratios (RRs) and the risk differences (RDs) regarding ACL Injuries. The RD was utilized to ascertain the number needed to treat. The search strategy identified 743 studies, of which 11 met all inclusion and quality criteria for pooled analysis. The total number of study participants was 16,316. The overall RR of sustaining an ACL injury in the intervention group was 0.36 (95% confidence interval [CI]: 0.23 to 0.57) of the control group, showing a significant reduction in the ACL injury risk of the intervention group (p < 0.001). We identified an RD of -1.4% (95% CI: -2.4% to -0.4%) in favour of the intervention group. The number needed to treat in preventing one ACL rupture was 71. In conclusion, the study clearly demonstrates a significant positive preventive effect of training programmes concerning ACL injuries (p < 0.001). The pooled estimates indicate that such programmes result in a significant reduction of ACL injury risks (p < 0.001). Despite the moderate quality of the included literature, the results exhibit robustness. However, based on the literature examined, no definitive superior training programme could be identified. II.

Abstract 4135178: Short Term Outcomes Of Transcatheter Tricuspid Valve Interventions On Post-Procedural Length Of Hospital Stay, Readmissions For Heart Failure And Procedure Success If An Intracardiac Device Is Present: A Systematic Review And Meta-Analysis In A New Era Of Tricuspid Interventions

Background: Tricuspid regurgitation (TR) is no longer considered forgotten. Transcatheter tricuspid valve repair/replacement (TVRR) has become widely accepted as gauged by clinical outcomes. FDA approved two tricuspid valve devices for the purpose of improving quality of life and not necessarily to improve TR severity. We aim to support evidence-based use of TVRR, by summarizing the latest evidence on the clinical effectiveness in terms of post-procedural length of hospital stay, readmissions for heart failure and procedure success if an Intracardiac device is present. Methods: We searched Pubmed, Embase and Cochrane databases and performed a meta-analysis of the included cohort studies using a fixed-effects model. Studies were excluded if they did not present an outcome in each intervention group or did not have enough information required for continuous data comparison. We performed a meta-analysis of hazard ratio (HR) for two outcomes and odds ratio (OR) for one outcome using the random effects model to remove inconsistency and compared the results with fixed effects model. The compared findings of both methods were similar. The variables used for analysis were number of events in exposure group and total amount of events. All data analyses were performed using MedCalc® Statistical Software version 22.023. Results: Of 161 potentially relevant studies, 8 retrospective studies with a total of 1,717 patients were included in the meta-analysis. Procedure (TVRR) success was associated with fewer readmissions for heart failure in all three studies included in the analysis of pooled HR (HR = 0.46, 95% confidence interval [CI]: 0.33 - 0.63, p&lt;0.001). Procedure success was also associated with shorter length of hospitalization post-procedure in all three studies included in the analysis of pooled HR (HR = 0.48, 95% CI: 0.33 - 0.72, p&lt;0.001). There was no significant association between procedure success and having an intra-cardiac device in all three studies included in the analysis of pooled OR (OR = 0.79, 95% CI: 0.56 - 1.12, p=0.18). Conclusion: Our meta-analysis showed that successful TVRR for high risk patients with severe TR is associated with significant positive outcomes on post-procedural length of hospital stay and readmissions for heart failure, regardless of presence of an intracardiac device. With emerging improvements in device technology and procedural performance, TVRR should be considered in severe and functional TR, to improve clinical prognosis.

Abstract 4129733: Glucagon-like Peptide 1 Receptor Agonists Effect on Low-Density Lipoprotein Cholesterol and Total Cholesterol Levels Independent of Weight Reduction: A Meta-analysis and Meta-regression of Placebo-controlled Randomized Controlled Trials

Background: The impact of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on lipid components is unclear. The objective of this study was to measure the lipid-lowering effect of GLP-1RAs. Methods: A thorough database search was performed to identify placebo-controlled randomized controlled trials (RCTs) on GLP-1RA therapy through January 2023. From these trials, data was extracted and a robust statistical analysis was performed using a random effects model to determine outcomes with weighted mean difference (MD) in milligrams per deciliter (mg/dL) and 95% confidence intervals (CIs). The primary outcome was the mean difference in low-density lipoprotein cholesterol (LDL-C). Secondary outcomes were mean differences in total cholesterol (TC), triglycerides, high-density lipoprotein-C (HLD-C), and very low-density lipoprotein-C (VLDL-C). To account for covariates, subgroup analyses and meta-regression were performed. Results: A total of 33 studies were included in the final meta-analysis carried out between 2008 and 2023, which were conducted in 26 countries. Of the 5,918 participants, the study population comprised 2,603 (44%) males and 3,315 (56%) females, aged between 33.7 and 65.9 years. GLP-1RAs significantly reduced LDL-C compared to placebo (MD -2.93, 95% CI (-5.01, -0.85), P=0.01). Treatment effect was consistent regardless of duration of treatment;12 weeks or less MD: -5.39, 95% CI (-10.36, -0.42), P=0.03 vs &gt;12 weeks MD: -2.39, 95% CI (-4.70, -0.007), P=0.04, P interaction 0.28). In our analysis, GLP-1RA reduced TC by ~7 mg/dl. There was no significant reduction in triglycerides (MD = -7.19, 95% CI (- 15.01, 0.62], P=0.07) and VLDL-C ~4 mg/dl (MD = -3.99, 95%, CI (-8.73, 0.75), P=0.10). Furthermore, GLP-1RA did not increase HDL-C (MD = -0.12, 95% CI (-0.73, 0.49], P=0.69. Regression analysis determined that weight loss did not affect the treatment effect on LDL-C (tau2=28.38, I2=99.83, R2=0.0, p=0.67), and total cholesterol (tau2=93.6, I2=99.86, R2=0.0, p=0.92). Conclusion: Patients on GLP-1RA experienced modest LDL-C and TC lowering compared to placebo. GLP-1RA did not decrease triglycerides and VLDL-C. GLP-1RA did not increase HDL-C.

Abstract 4131488: Artificial Intelligence-Enhanced Electrocardiogram for the Diagnosis of Cardiac Amyloidosis: A Systemic Review and Meta-analysis

Background: Diagnosis of cardiac amyloidosis (CA) is often delayed due to variability in clinical presentation. The electrocardiogram (ECG) is one of the most common and widely available tools for assessing cardiovascular diseases. Artificial intelligence (AI) models analyzing ECG have recently been developed to detect CA, but their pooled accuracy is yet to be evaluated. Aim: To meta-analyze the accuracy of AI-enhanced ECG in diagnosing CA. Methods: We searched the Scopus, MEDLINE, and Cochrane CENTRAL databases up until April 2024 for studies assessing AI-enhanced ECG diagnosis of CA. Studies reporting findings from derivation and validation cohorts were included. Studies combining other diagnostic modalities such as echocardiography were excluded. The outcome of interest was the area under the receiver operating characteristic curve (AUC) for overall CA and subtypes transthyretin amyloidosis (ATTR) and light chain amyloidosis (AL). Analysis was done using RevMan 5.4.1 general inverse variance random effects model, pooling data for AUC and 95% confidence intervals (CI). Results: 5 studies comprising 7 cohorts met the eligibility criteria. The total derivation and validation cohorts were 8,639 and 3,843 respectively. The AUC were 0.89 (95% CI, 0.86-0.91) for cardiac amyloidosis, 0.90 (95% CI, 0.86-0.95) for ATTR amyloidosis and 0.80 (95% CI, 0.80-0.93) for AL amyloidosis. The forest plots can be found in the Figure 1. Conclusion: AI-enhanced ECG models effectively detect CA and may provide a useful tool for the early detection and intervention of this disease.

Abstract 4137188: Racial and Ethnic Disparities in Catheter Ablation for Atrial Fibrillation: A Systematic Review and Meta-Analysis

Background: Atrial fibrillation (AF) is the most prevalent arrhythmia globally, with an escalating incidence in the United States. It is known that racial and ethnic disparities exist in the management of AF. Although current guidelines recommend catheter ablation (CA) as one of the most effective rhythm control strategies, recent data suggest that minority populations, including Black, Hispanic, and Asian individuals with AF, are less likely to undergo CA, and aggregate data are lacking in this area. Aims/Hypothesis: To determine differences in CA rates and the likelihood of undergoing CA for AF in racial/ethnic minority populations compared to Caucasians. We hypothesized that minorities are less likely to undergo CA for AF than their non-minority counterparts. Methods: A systematic search of PubMed, EMBASE, and Cochrane Library, based on an a priori registered protocol (PROSPERO Registration CRD42024496174), from January 1st, 2010, to January 2nd, 2024, was conducted to identify studies with ≥ 500 participants assessing CA use in AF in at least two racial/ethnic groups. Data were combined using a random-effects model meta-analysis. Results: A total of 431 non-duplicate records were identified. After independent screening based on inclusion/exclusion criteria, 19 studies comprising 12,598,109 patients were included. Among them, 9,577,652 (76.0%) were White, 789,954 (6.3%) were Black, 476,216 (3.8%) were Hispanic, 113,005 (0.9%) were Asian, while 1,641,282 (13.0%) were classified as other or were missing race/ethnicity data. The proportion of White subjects who underwent CA for AF was 4% (95% CI 3-5%). In contrast, the proportion of Black, Hispanic, and Asian individuals with AF who underwent CA was 2% (95% CI 1-3%), respectively, for each group. Pooled odds ratios (OR) of having CA for AF compared to Whites were 0.68 (95% CI 0.56 - 0.83), 0.72 (95% CI 0.63 - 0.82), 0.64 (95% CI 0.48 - 0.86) for Blacks, Hispanics, and Asians, respectively. Conclusions: The use of CA among the total AF population was low across all ethnic groups. Moreover, racial/ethnic minority groups were significantly less likely to undergo CA compared to White patients.

Abstract 4116692: Cardiovascular Safety of Fertility Therapy: A Systematic Review and Meta-Analysis

Background and Aims: The increasing use of assisted reproductive technology (ART) has raised concerns regarding its long-term cardiovascular safety due to potential hormonal imbalances and pro-thrombotic states. This study aimed to assess the long-term cardiovascular risk associated with fertility treatments in women. Methods: Following PRISMA guidelines, a systematic review and meta-analysis was conducted via MEDLINE (Pubmed) from inception to January 2024. Randomized, cohort or case-control studies were included if fulfilling the following criteria: the association between fertility therapy and the subsequent cardiovascular outcome was reported and conditioned on confounding factors (at least age); the presence of a control group; minimum one-year follow-up. Effect size (ES) estimates of the association between fertility therapy and subsequent cardiovascular disease were pooled using the DerSimonian and Laird random-effects model. Heterogeneity was assessed with the I 2 index. This study is registered with PROSPERO (CRD42024505605). Results: Of 7,298 articles screened, eleven studies were included, encompassing 606,912 women undergoing ART and 70,562,486 controls. The analysis found no increase in the long-term risk of major adverse cardiovascular events (ES=0.97, 95% CI=0.81-1.16, I 2 =89.55%, p=0.73), coronary heart disease (ES=0.88, 95% CI=0.71-1.10, I 2 =24.36%, p=0.26), stroke (ES=1.20, 95% CI=0.96-1.49, I 2 =48.33%, p=0.11), heart failure (ES=0.74, 95% CI=0.60-0.94, I 2 =0.00%, p=0.01), venous thromboembolism (ES=1.03, 95% CI=0.78-1.34, I 2 =54.41%, p=0.85), hypertension (ES=1.08, 95% CI=0.88-1.326, I 2 =94.63%, p=0.46), or diabetes (ES=1.03, 95% CI=0.86-1.22, I 2 =78.44%, p=0.77). Conclusions: ART does not increase the long-term risk of cardiovascular diseases in women. These results support the cardiovascular safety of fertility treatments, though further research into specific ART techniques and extended follow-up is recommended.

Abstract 4120898: Assessment of Subclinical Atherosclerosis in Psoriasis Patients Using Echocardiographic Coronary Flow Parameters: A Systematic Review and Meta-Analysis

Background: Chronic inflammatory diseases are associated with a higher risk for atherosclerosis and adverse cardiovascular events. Psoriasis is a systemic inflammatory condition that significantly increases coronary artery disease risk. Subclinical atherosclerosis can be estimated by echocardiographic parameters like coronary flow velocity reserve (CFVR), diastolic peak flow velocity (DPFV), and hyperemic DPFV. Limited literature investigates these parameters in psoriasis, with inconsistent results. Methods: We systematically searched the major bibliographic databases including PubMed, Embase, Cochrane Library, and Google Scholar from inception to 7th May 2024 to retrieve relevant studies. The outcomes were pooled using the inverse variance random-effects model, and the results were presented as standardized mean difference (SMD) with the corresponding 95% confidence interval (CI). Results: 4 studies with 557 participants (281: psoriasis and 276: controls) were included. The mean age of the psoriasis group was 44.7 ± 7.7 years and of the control group was 45.2 ± 5.9 years. Psoriasis patients had a significantly lower CFVR [SMD: -0.71; 95% CI: -0.97, -0.45; p&lt;0.00001] and hyperemic DPFV [SMD: -0.71; 95% CI: -1.30, -0.12; p=0.02] compared to healthy controls. However, the difference between baseline DPFV was insignificant between the two groups [SMD: 0.20; 95% CI: -0.92, 1.32; p=0.73]. Conclusion: This study demonstrates that psoriasis is associated with coronary microvascular disease as measured by significantly lower CFVR and hyperemic DPFV. These results suggest that impaired myocardial perfusion in psoriasis patients may be an early manifestation of cardiac involvement. Hence, early risk stratification in psoriasis patients is crucial. Further large, randomized trials are essential to corroborate the results of this meta-analysis.

Abstract 4113561: Efficacy and Outcomes of Empagliflozin in Acute Coronary Syndrome Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background: Sodium-glucose co-transporter 2 inhibitors (SGLT2i) have demonstrated mortality benefits in patients with heart failure (HF). Since acute coronary syndrome (ACS) is an increasingly prevalent cardiovascular condition that often leads to HF, SGLT2i might play a role in reducing mortality in these patients. Previous randomized controlled trials (RCTs) have demonstrated inconsistent efficacy of Empagliflozin, an SGLT2i, in patients with ACS. Methods: A comprehensive systematic literature search was conducted spanning the major bibliographic databases to retrieve RCTs comparing Empagliflozin to placebo in patients with ACS. Odds ratios (OR) and mean differences (MD) with 95% confidence intervals were pooled using the DerSimonian and Laird random-effects model with statistical significance set at p&lt;0.05. Results: 5 RCTs were included with 7229 ACS patients (3608 in the Empagliflozin group and 3621 in the placebo group). Empagliflozin treatment was not associated with a statistically significant difference in all-cause mortality [OR: 0.94; 95% CI: 0.76, 1.17; p=0.60], cardiovascular death [OR: 1.00; 95% CI: 0.79, 1.28; p=0.99], hospitalization for heart failure [OR: 0.86; 95% CI: 0.42, 1.74; p=0.67], serious adverse events [OR: 1.85; 95% CI: 0.29, 11.87; p=0.51], LVEF on follow-up [MD: 4.35; 95% CI: -4.52, 13.23; p=0.34], NT-ProBNP [MD: -126.02; 95% CI: -279.37, 27.32; p=0.11], estimated glomerular filtration rate [MD: 1.59; 95% CI: -1.35, 4.52; p=0.29], and HbA1c [MD: -0.17; 95% CI: -0.53, 0.20; p=0.38] compared to placebo. Conclusion: This study concludes no statistical difference in all-cause mortality, cardiovascular death, and hospitalization for heart failure with empagliflozin therapy in ACS patients compared to placebo, however, the largest study (EMPACT-MI) had a statistically significant difference in hospitalizations for HF. Further large multicentric RCTs are warranted to validate these findings.

Abstract 4134845: Primary Percutaneous Coronary Intervention versus Thrombolytic Therapy Outside Cardiology Reference Center for Acute Myocardial Infarction: A Meta-Analysis of Randomized Control Trials

Introduction: Fibrinolysis is the treatment of choice for patients with ST-elevation acute myocardial infarction (STEMI) who cannot reach door-to-balloon time for primary reperfusion therapy (PCI) 1. This therapy is widely used in some countries in Europe and Brazil2. However, these patients who undergo thrombolysis have a higher mortality rate compared to patients who undergo primary PCI3. The objective of the study is to evaluate the outcomes of mortality, reinfarction and stroke in patients with STEMI who underwent thrombolysis outside referral centers (community hospitals and inside ambulances) versus patients who underwent primary PCI. Methods: We performed a systematically review and meta-analysis of randomized control trials (RTCs) comparing of pre-hospital thrombolysis (PHT) with primary coronary intervention (PCI). PubMed, Embase and Cochrane databases were searched from April 2024 with the following search terms: ‘STEMI’, ‘myocardial infarction’[Mesh],’pre hospital’,’thrombolysis’,PHT, ‘thrombolytic therapy’. We used random-effects model to estimate the Risk Ration (RR) with 95% CI. Heterogeneity was examined with I2 statistics. We also performed leave-one-out sensitivity analyses and used Review Manager 5.4 for statistical analysis. The study was registered on PROSPERO: CRD42024547309. Results: A total of 1890 patients from 3 studies RTCs were included. Pre-hospital thrombolysis was used to treat STEMI in 940 patients (49%). Follow-up time varied from 4.6 to 5 years. The average age was 60.3 years. The anterior infarction on the ECG was similar between groups: average 43% (PHT) and 41.6% (PCI). Pre-hospital thrombolysis was associated with a higher risk of reinfarction ( RR 2.33; 95% CI 1.30-4.16; p=0.004; I2=0%) and composite outcomes of stroke, mortality and reinfarction(RR 1.67; 95% CI 1.25-2.23; p=0.0005; I2=0%). No significant differences were found between treatment groups regarding mortality (RR 1.23; 95% CI 0.70-2.18; p=0.47; I2=42%) and stroke (RR 3.82; 95% CI 0.54-27.23; p=0.18; I2=38%). Conclusion: This study suggests that pre-hospital thrombolysis is associated with a higher risk of reinfarction. More randomized studies on patients treated in a pre-hospital environment are needed to better investigate this question.

Abstract 4121516: Efficacy of Sentinel Cerebral Embolic Protection Device in Transcatheter Aortic Valve Replacement: A Meta-Analysis of Randomized Controlled Trials and Propensity Score Matched Studies

Background: Transcatheter aortic valve replacement (TAVR) is frequently associated with stroke due to debris embolization. Although the risk of stroke with the newer-generation devices is lower, stroke still represents a significant cause of mortality and morbidity after TAVR. The Sentinel cerebral embolic protection (CEP) device (Boston Scientific) is a dual embolic filter device designed to capture debris dislodged during TAVR. The current literature concerning the efficacy of Sentinel CEP in the reduction of stroke in patients undergoing TAVR is limited and inconsistent. Aim: This meta-analysis aimed to compare clinical outcomes with Sentinel CEP device in patients undergoing TAVR. Methods: A comprehensive systematic literature search was performed on PubMed, Embase, Cochrane Library and Clinicaltrial.gov from inception until 1st May 2024 to retrieve randomized controlled trials (RCTs) and propensity-matched studies comparing TAVR with and without the Sentinel CEP device. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated using the DerSimonian-Laird random-effects model, with a p-value of &lt;0.05 considered statistically significant. Results: 6 studies with a total of 25,130 patients undergoing TAVR (12608: Sentinel CEP device; 12522: Without Sentinel CEP device) were included in this meta-analysis. The use of the Sentinel CEP device in TAVR was associated with a statistically significant lower risk of acute kidney injury [OR: 0.89; 95% CI: 0.81, 0.97; p=0.01]. The use of Sentinel CEP device in TAVR was associated with a statistically insignificant trend towards reduction in stroke [OR: 0.80; 95% CI: 0.58, 1.10; p=0.18], all-cause mortality [OR: 0.74; 95% CI: 0.51, 1.07; p=0.11], and major vascular complications [OR: 0.74; 95% CI: 0.46, 1.19; p=0.21]. Conclusion: The use of the Sentinel CEP device in patients undergoing TAVR does not lead to a statistically significant reduction in stroke, all-cause mortality, and major vascular complications; however, the risk of acute kidney injury is lower. Large, multicentric RCTs are warranted to corroborate the findings of this meta-analysis.

Abstract 4136704: Comparison of Early Clinical Outcomes with Balloon-Expanding Valves Versus Self-Expanding Valves in Transcatheter Aortic Valve Replacement: A Meta-Analysis of Randomized Controlled Trials

Background: Transcatheter aortic valve replacement (TAVR) is an effective percutaneous intervention in patients with severe aortic stenosis, particularly in those with contraindications for surgical repair. Currently, two types of aortic valves are used in clinical practice: balloon-expanding valves (BEV) and self-expanding valves (SEV). The current data comparing early (30-day) clinical outcomes of BEV to SEV in patients with severe aortic stenosis undergoing TAVR are inconsistent. Methods: A systematic literature search spanning PubMed, Embase, Cochrane, and Scopus databases was conducted to retrieve randomized controlled trials (RCTs) comparing balloon-expanding valves to self-expanding valves in patients undergoing TAVR. The DerSimonian and Laird random-effects model was used to pool the odds ratios (OR) with 95% confidence intervals. Statistical significance was set at p&lt;0.05. Results: This meta-analysis included five RCTs with 2190 severe aortic stenosis patients (1097 in the BEV group and 3621 in the SEV group). BEV-TAVR was associated with a significantly lower risk of 30-day new permanent pacemaker (PPM) implantation [OR: 0.67; 95% CI: 0.48, 0.93; p=0.02] and 30-day re-hospitalization for heart failure [OR: 0.20; 95% CI: 0.04, 0.96; p=0.04] compared to SEV-TAVR. The risks of 30-day mortality, 30-day cardiac mortality, 30-day all-cause stroke, 30-day myocardial infarction, 30-day life-threatening bleeding, 30-day vascular complications, 30-day acute kidney injury, and 30-day repeat procedures for valve-related dysfunction were comparable between the two groups. Conclusion: TAVR in patients with severe aortic stenosis using BEV is advantageous over SEV in terms of 30-day new PPM implantation and 30-day rehospitalization for heart failure, with comparable risks for other outcomes. These findings underscore the safety and efficacy of newer generation valves, including Sapien 3 and EvolutPro, in TAVR. The choice of prosthetic aortic valve is dependent on individual anatomy and operator preference. Further RCTs are warranted to evaluate other newer-generation valves with varying severities of aortic stenosis.

Abstract 4132498: Hemodynamic and Clinical Outcomes with Balloon-Expandable Valves Versus Self-Expanding Valves in Patients with Small Aortic Annulus Undergoing Transcatheter Aortic Valve Implantation: A Meta-Analysis of Randomized Controlled Trials and Propensity Score Matched Studies

Background: Transcatheter aortic valve implantation (TAVI) is thought to be more effective than surgery for patients with small aortic annulus (SAA), however, the comparative efficacy of different transcatheter heart valves (THVs) remains uncertain. The objective of this meta-analysis was to compare the effects of balloon-expandable valves (BEVs) and self-expanding valves (SEVs) on hemodynamic parameters and clinical outcomes in patients with SAA who underwent TAVI. Methods: A thorough literature search was performed across PubMed/MEDLINE, Embase, and the Cochrane Library from their inception until May 2024 to identify eligible randomized controlled trials (RCTs) and propensity-score matched (PSM) studies. Clinical outcomes were evaluated using a random-effects model to pool risk ratios (RRs) with 95% confidence intervals (CIs). Results: The analysis included 8 studies; 2 RCTs and 6 PSM studies, with a total of 2,180 patients with SAA. BEVs were associated with a smaller indexed effective orifice area (MD: -0.18, 95% CI: -0.31 to -0.05) and a higher transvalvular mean pressure gradient (MD: 5.23, 95% CI 3.44 to 7.02) than SEVs. The risk for prosthesis-patient mismatch (PPM) (RR= 1.82, 95% CI: 1.27 to 2.60) and severe PPM (RR= 2.77, 95% CI: 1.93 to 3.98) was significantly higher for patients receiving BEVs than those receiving SEVs. However, no significant difference was observed between BEVs and SEVs regarding the risk of paravalvular leak (RR= 0.98, 95% CI: 0.57 to 1.69) and the permanent pacemaker implantation (RR= 0.78, 95% CI: 0.50 to 1.23). Although patients receiving BEVs showed a slightly lower risk of major bleeding events (RR= 0.69, 95% CI: 0.49 to 0.99), BEVs were associated with a significantly increased risk of 1-year cardiovascular mortality (RR= 1.61, 95% CI: 1.05 to 2.47) compared to those receiving SEVs. However, no significant differences were observed between BEVs and SEVs regarding 30-day all-cause mortality (RR= 1.19, 95% CI: 0.57 to 2.49), 1-year all-cause mortality (RR= 1.17, 95% CI: 0.89 to 1.53), stroke rates (RR= 0.83, 95% CI: 0.52 to 1.31) and any vascular complication (RR= 1.13, 95% CI: 0.72 to 1.75). Conclusion: In patients with SAA, SEVs showed reduced risks of PPM and severe PPM compared to BEVs, along with a larger indexed effective orifice area. Moreover, SEVs were associated with a lower risk of 1-year cardiovascular mortality.

Association Between Gallstone Disease and Kidney Stone Disease: A Systematic Review and Meta-analysis

Background and aims: Gallstone disease (GSD) and kidney stone disease (KSD) have increased due to lifestyle in recent decades. This systematic review and meta-analysis aimed to investigate the association between these two diseases. Methods: A comprehensive electronic database search was conducted before August 25, 2024. This systematic review and meta-analysis included observational studies. The meta-analysis employed a random-effects model to compute the overall summary estimates of the association between GSD and KSD using risk ratios with 95% confidence intervals (CIs) as the primary measure of the effect size. Heterogeneity was evaluated using chi-square tests, the I² statistic, and forest plots. Publication bias was assessed through Begg’s and Egger’s tests. A P value of less than 0.05 was considered statistically significant, and all analyses were performed using Stata 17 software. Results: The meta-analysis included 9 studies encompassing 982847 participants. The pooled analysis revealed a statistically significant association between GSD and KSD, with a risk of 1.78 (95% CI: 1.572.03, P≤0.001). Begg’s and Egger’s tests demonstrated no significant bias (Begg’s test P=0.835, Egger’s test P=0.812). Variables such as study year, sample size, mean age of participants, mean follow-up, and study quality as determined by the Newcastle-Ottawa Scale (NOS) were examined, but none could significantly impact heterogeneity (P&gt;0.10). Conclusion: This systematic review and meta-analysis provide evidence of a significant association between GSD and KSD. Therefore, further investigation into the underlying mechanisms and potential risk factors is necessary.

Abstract 4136971: Prognostic Value of Late Gadolinium Enhancement to Predict Non-Sustained Ventricular Tachycardia in Patients with Hypertrophic Cardiomyopathy: A Systematic Review and Meta-Analysis

Background: Non-sustained ventricular tachycardia (NSVT) has been shown to be independently associated with sudden cardiac death (SCD) among patients with hypertrophic cardiomyopathy (HCM). There is limited evidence regarding the efficacy of late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging to predict the incidence of NSVT. Aims: To address this gap in knowledge, our meta-analysis aims to comprehensively evaluate the prognostic value of LGE on cardiac magnetic resonance in predicting the incidence of NSVT in HCM. Methods: PubMed, Embase and Cochrane CENTRAL databses were queried from inception until May 2024 for all studies assessing the prognostic value of LGE on CMR in patients with HCM and reported the incidence of NSVT. Data were combined using a random-effects model meta-analysis to determine the pooled sensitivity, specificity and accuracy of LGE in predicting NSVT in patients with HCM. The association between the LGE extent on CMR and NSVT incidence was also assessed, and weighted mean differences (WMDs) were reported with 95% condidence intervals (CIs). Heterogeneity across the studies was evaluated using the Higgins I 2 statistic. Results: A total of twenty studies were included in our analysis. The pooled senstivity, specificity, and accuracy of LGE in predicting the incidence of NSVT among HCM patients was 91.33%, 37.45%, and 52.86%, respectively. Moreover, we saw a significantly greater extent of LGE (5.95%, CI: 3.08-8.81, P&lt;0.0001) in patients who had NSVT, as compared to patients without NSVT ( Figure 1). Conclusion: Our meta-analysis underscores the significant prognostic value of LGE as a risk stratification tool on CMR imaging in predicting the incidence of NSVT in patients with HCM, by demonstrating a high sensitivity, and a notable association between the LGE extent and NSVT incidence. Nevertheless, the low to moderate Ispecificity and accuracy underscores the need for additional imaging biomarkers for risk stratification.

Abstract 4120105: Meta-Analysis of Outcomes in Patients Developing Acute Kidney Injury Following Thoracic Endovascular Aortic Repair for Stanford Type B Aortic Dissection

Background and Aims: Thoracic endovascular aortic repair (TEVAR) is warranted in patients with Stanford Type-B aortic dissection who are at an increased risk of aneurysm rupture and enlargement. While studies indicate that development of post-operative acute kidney injury (AKI) (with incidence rate varying from 1.5% to 34%) may potentially worsen outcomes and increased mortality, the specific role of AKI in the postoperative period for patients undergoing TEVAR for Stanford Type-B aortic dissection remains understudied and unclear. Our meta-analysis aims to contribute valuable insights into this aspect. Methods: A comprehensive literature search spanning major bibliographic databases was conducted to retrieve studies comparing outcomes in Stanford Type-B aortic dissection patients undergoing TEVAR who developed AKI postoperatively versus those who did not. Our outcomes of interest included the risk of in-hospital mortality, stroke, and requirement for dialysis. Relative risks (RRs) were pooled from all studies using DerSimonian and Laird random-effects models in the ‘meta’ package of R software (Version: 2023.12.1+402). Statistical significance was set at p &lt;0.05. Results: Three studies were included with 1091 patients (234 in the AKI group and 857 in the non-AKI group). The development of AKI was associated with a significantly higher risk of in-hospital mortality [RR: 5.31; 95% CI: 3.10, 9.08; p&lt;0.0001; I 2 =0%], a higher risk of stroke [RR: 2.33; 95% CI: 1.30, 4.17; p=0.0046; I 2 =0%], and an increased risk of requiring dialysis [RR: 18.43; 95% CI: 3.35, 101.46; p=0.0008; I 2 =0%] (Figure 1). No heterogeneity was observed between the studies (Figure 1 and 2). Conclusion: The development of AKI after TEVAR in patients with Stanford Type-B aortic dissection is associated with an increased risk of in-hospital mortality, stroke, and dialysis requirement. Hence, further research into early recognition of the risk factors associated with the development of AKI after TEVAR is warranted, along with determining its effects in longer follow-up durations.

Abstract 4121215: Efficacy and Safety of Empagliflozin in Patients with Acute Myocardial Infarction: A meta-analysis of randomized controlled trials

Background: Empagliflozin is a sodium glucose co-transporter 2 inhibitor that improves cardiovascular outcomes in patients with type 2 diabetes mellitus, chronic kidney disease and heart failure. Less is known about the efficacy and safety of empagliflozin in patients after acute myocardial infarction. Methods: PubMed, Embase and Cochrane databases were searched for randomized controlled trials (RCTs) that reported the outcomes of interets including all-cause mortality, death from cardiovascular causes, hospitalization due to heart failure etc. Risks ratios (RR) or mean difference (MD) and their 95% confidence intervals (CIs) were computed with the use of random-effect model. Heterogeneity was examined with I 2 statistics. Results: We included 12 RCT articles consisting of 23,178 patients that received empagliflozin after acute myocardial infarction were considered. Empagliflozin was associated with significantly reduced incidence of all-cause mortality (RR 0.72; 95% CI [0.61, 0.85]; P &lt; 0.0001; 5.9% vs 7.4%), death from cardiovascular causes (RR 0.66; 95% CI [0.52, 0.83]; P = 0.0004; 4.0% vs 5.4%), and hospitalization for heart failure (RR 0.66; 95% CI [0.58, 0.76]; P &lt; 0.00001; 3.2% vs 4.7%), acute kidney injury (RR 0.52; 95% CI [0.31, 0.86]; P = 0.01), acute renal failure (RR 0.71; 95% CI [0.55, 0.91]; P = 0.008), adverse events leading to discontinuation (RR 0.89; 95% CI [0.80, 0.99]; P = 0.03), systolic blood pressure (MD -8.59; 95% CI [-13.26, -3.93], P = 0.0003), and thromboembolic events (RR 0.51; 95% CI [0.28, 0.92]; P = 0.03) compared to placebo. However, there was no significant difference between groups with respect to fatal or nonfatal stroke (RR 1.15; 95% CI [0.91, 1.46]; P = 0.23), adverse events leading to lower limb amputation (RR 1.11; 95% CI [0.62, 1.99]; P = 0.73), estimated glomerular filtration rate (MD 0.45; 95% CI [-0.20, 1.10]; P = 0.17), diastolic blood pressure (MD -2.53; 95% CI [-5.40, 0.34]; P = 0.08), body weight (MD -1.04; 95% CI [-4.08, 1.99]; P = 0.50), urinary tract infection (MD 1.04; 95% CI [0.92, 1.17]; P = 0.55), NT- proBNP (MD -115.93; 95% CI [-271.52, 39.66]; P = 0.14), glycated hemoglobin (MD -0.10; 95% CI [-0.41, 0.22]; P = 0.55), and hypoglycemia (RR 0.98; 95% CI [0.89, 1.08]; P = 0.70). Conclusion: Our findings suggest that empagliflozin has superior efficacy and safety compared to placebo for the treatment of patients with acute myocardial infarction with no impact on UTI, eGFR, NT-proBNP, and hypoglycemia.

Hyoid Bone Position and Upper Airway Morphology of Children With Obstructive Sleep Apnea: A Systematic Review and Meta-analysis.

The objective of this systematic review was to summarise the existing evidence regarding hyoid bone position and upper airway morphology of children with obstructive sleep apnea (OSA). Electronic searches were carried out in PubMed, Embase, Web of Science, CINAHL and WorldCat databases without any restrictions on language from inception to March 2024. The studies which compared the hyoid bone position and upper airway morphology using lateral cephalograms between children with and without OSA will be included. The methodological quality of the included studies was assessed using Newcastle-Ottawa Scale, and the meta-analysis was conducted utilising random-effects model. Twelve cross-sectional studies and one case-control study were included. One study was rated as low quality, three as medium quality, five as high quality, and four as very high quality. Meta-analysis showed that compared to healthy children, children with OSA tended to have increased distance between hyoid bone and mandibular plane (Hy-MP, MD: 3.33, 95% CI: 1.90 to 4.77, p < 0.00001, I2 = 72%), increased distance between hyoid bone and cervical vertebra (Hy-C3, MD: 1.54, 95% CI: 0.62 to 2.46, p = 0.001, I2 = 68%), and a smaller airway space behind the soft palate (U-MPW, MD: -3.07, 95% CI: -4.76 to -1.38, p = 0.0004, I2 = 68%). Whereas there was no significant difference in inferior posterior airway space between children with OSA and healthy controls (IPAS, MD: -1.51, 95% CI: -3.37 to 0.35, p = 0.11, I2 = 71%). In children with OSA, the hyoid bone may exhibit a more anterior and inferior position and the airway posterior to the soft palate demonstrated a narrower dimension. Registration: PROSPERO (CRD42024528171).

Abstract 4138782: A Meta-Analysis Comparing Same-Day Discharge to Later-Day Discharge in Transcatheter Aortic Valve Replacement

Background: One of the benefits of transcatheter aortic valve replacement (TAVR) over surgical aortic valve replacement (SAVR) is the possibility of same-day discharge, allowing for early mobilization and reduced total hospital stay. However, there is limited evidence comparing same-day discharge to later-day post-TAVR discharge. This meta-analysis aimed to compare the outcomes of same-day and later-day discharge post-TAVR in patients with aortic stenosis. Methods: A systematic bibliographic search was conducted using electronic databases, including PubMed, Embase, and the Cochrane Library, from inception to May 23, 2024. We pooled the risk ratios (RR) with 95% confidence intervals (CI) using the inverse-variance random-effects model. Statistical significance was set at p &lt;0.05. Results: Six studies were included with 71,550 patients undergoing TAVR (2215: same-day discharge; 69335: later-day discharge). The mean age for the same-day and later-day discharge groups was 77.3 ± 8.3 and 78.3 ± 8.5, respectively. Same-day discharge for patients post-TAVR was associated with a higher risk of 30-day stroke [RR: 1.93; 95% CI: 1.14, 3.27] and 30-day major vascular complications [RR: 1.82; 95% CI: 1.02, 3.24] as compared to later-day discharge post-TAVR. However, no significant differences in the risks of 30-day mortality [RR: 0.30; 95% CI: 0.06, 1.57], 30-day readmission [RR: 0.93; 95% CI: 0.66, 1.32], 30-day major bleeding [RR: 0.86; 95% CI: 0.52, 1.42], 30-day new permanent pacemaker [RR: 1.00; 95% CI: 0.81, 1.22], 30-day acute kidney injury [RR: 1.04; 95% CI: 0.73, 1.49], and 30-day valve reintervention [RR: 5.77; 95% CI: 0.60, 55.39] were noted between the two groups. Conclusion: This meta-analysis concluded that same-day discharge post-TAVR is associated with a higher risk of 30-day stroke and 30-day major vascular complications than later-day discharge after TAVR. Same-day discharge was comparable to later-day discharge post-TAVR in terms of 30-day mortality, 30-day readmission, 30-day major bleeding, 30-day new permanent pacemaker, 30-day acute kidney injury, and 30-day valve reintervention. This study underscores the possibility of same-day discharge after uncomplicated TAVR in select patients. Further randomized studies are required to evaluate the safety and feasibility of the same-day discharge protocols.