Reduction In Total Mortality Research Articles

Efficacy and Safety of Tranexamic Acid in Traumatic Brain Injury: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Traumatic brain injury (TBI) is a major global health concern, contributing significantly to mortality and long-term disability. Tranexamic acid (TXA), an antifibrinolytic agent, has demonstrated potential in reducing mortality in trauma patients, but its specific efficacy and safety in TBI management remain under investigation. This systematic review and meta-analysis aim to evaluate the efficacy and safety of TXA in patients with TBI by synthesizing data from randomized controlled trials (RCTs).A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and Cochrane CENTRAL databases about the studies conducted from January 2005 up to December 10, 2022. Eligible studies included RCTs involving TBI patients of any age, where the experimental group received TXA, and the control group received a placebo. The primary outcome was total mortality, focusing on the overall survival impact of the intervention. Secondary outcomes included the need for neurosurgical intervention, pulmonary embolism, myocardial infarction, deep venous thrombosis (DVT), and stroke. Data were pooled using the DerSimonian-Laird random-effects model, with heterogeneity evaluated using the Cochrane Q test and I² statistic. Twelve RCTs encompassing 37,482 participants met the inclusion criteria. TXA administration was associated with a significant reduction in total mortality (relative risk (RR) 0.95, 95% confidence interval (CI) 0.90-0.99, P=0.002) compared to placebo, without increasing the risk of thromboembolic events such as DVT (RR 1.07, 95% CI 0.73-1.57, P=0.58) and pulmonary embolism (RR 0.97, 95% CI 0.78-1.22, P=0.82). The analysis showed no significant differences between the TXA and placebo groups concerning the need for neurosurgical intervention, incidence of myocardial infarction, or occurrence of stroke. Additionally, the studies demonstrated low to moderate heterogeneity across the assessed outcomes, indicating consistent findings regarding the treatment intervention and its associated complications. In conclusion, TXA significantly reduces total mortality in TBI patients without elevating the risk of thromboembolic complications. These findings support the integration of TXA into acute TBI management protocols, especially in settings requiring rapid intervention. Nevertheless, further research is necessary to optimize dosing regimens and administration timing and to assess the long-term functional outcomes associated with TXA use in TBI patients.

Abstract 4125999: Elderly patients with HF with reduced ejection fraction and renal failure: are SGLT2i a good option?

SGLT-2 receptor inhibitors (SGLT-2i) have been shown to reduce cardiovascular mortality and hospitalisations for heart failure (HF) in patients with HF with reduced ejection fraction (HFrEF) and to have a nephroprotective role in patients with chronic kidney disease (CKD). However, the available evidence in patients older than 75 years and with CKD is limited. We conducted a retrospective, single-centre study including patients aged >75 years diagnosed with HFrEF (defined as ejection fraction <40%), CKD (eGFR <60mL/min) and with an indication for treatment with SGLT-2i for HF between November 2019 and November 2022. Clinical, analytical, electrocardiographic and echocardiographic variables were collected. A total of 173 patients were included with a mean follow-up of 31.6 months (SD ±13.2). Mean age 84.7 years (SD ±4.9), 66.5% were male, 85.5% were hypertensive, 34.7% diabetic and 39.3% dyslipidaemic. Peripheral vascular disease was present in 11.6%. Mean glomerular filtration rate was 45.9 mL/min and only 2.3% were on haemodialysis. LVEF at inclusion was 29.5% (SD ±7.9), with 53.1% being of ischaemic aetiology and the most frequent functional class being NYHA II (53.2%). Thirty-seven percent had atrial fibrillation and 34.1% had complete left bundle branch block. At the end of follow-up 80.3% were on beta-blockers, 48.6% on ACE inhibitors, 37.6% on aldosterone antagonists, 23.7% on ARNI and only 11% on SGLT-2i. Survival analysis was performed using Cox logistic regression (multivariate analysis), where SGLT-2i was shown to be the only protective factor for all-cause mortality (HR 0.3 [0.1-0.9]). Male sex (HR 2.2 [1.3-3.9]) and diabetes (HR 1.6 [1.0-2.6]) were associated with higher mortality. The attached figure (figure 1) shows the Kaplan-Meier survival curves for total mortality in those patients with and without SGLT-2i (p log-rank 0.05). In our population, SGLT2i showed a significant reduction in total mortality in patients older than 75 years, with HFrEF and CKD. However, the treatment rate in this subgroup of patients is very low. Further implementation of SGLT2i treatment in this type of patient could be of significant clinical and prognostic benefit.

Exploiting Underutilised crops

Exploiting Underutilised crops

Epigenetic effects of selenium and vitamin E supplementation in broiler breeder diets on the performance of their progeny

Nutritional supplements have been commonly used in the poultry industry last few years. The study aimed to investigate the epigenetic effects of adding vitamin E and organic selenium to the diet of broiler breeders Ross-308 on their progeny meat production performance. The treatments included the control group fed with a standard diet without supplementation (T1), T2 using a standard diet supplemented with 500 mg of vitamin E / kg, T3 using a standard diet supplemented with 0.5 mg of organic selenium (Availa powder) /kg, and T4 using a standard diet supplemented with a mixture of vitamin E and organic selenium in proportions 500 and 0.5 mg/kg respectively. The eggs were collected from each treatment to obtain the progeny reared for 35 periods, and measurements were recorded for meat production and carcass traits. The results showed that the treatments had significant epigenetic effects on body weight at hatching. Hence, T2 had a significantly heavier body weight than T1, while no significant differences were observed between T3 and T4. The result of T2 recorded extremely high feed intake compared with T3. On the other hand, T3 and T4 recorded a hefty weight of breast parts compared with T1 and T2. In conclusion, organic selenium supplementation led to a significant increase in breast weight and a decrease in thigh part weight compared to the control group. In contrast, vitamin E supplementation led to an increase in chick weight at hatch, a reduction of total mortality and an improvement in feed conversion ratio compared to the control group. This refers to the epigenetic effects of organic selenium and vitamin E on progeny traits when added to the breeder diet. Keywords: Epigenetics, broiler, selenium supplementation, meat production

Optimal timing of intervention in non-ST-elevation acute coronary syndromes without pre-treatment

IntroductionIn patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS), an invasive strategy is recommended. However, the optimal timing to perform coronary angiography (CA) remains undetermined, and this issue has become particularly relevant since the 2020 European guidelines restricted pre-treatment (PT) with P2Y12 antagonists. ObjectiveTo assess the prognostic value of an early (ES; <24 h) versus a delayed strategy (DS; >24 h) when no loading dose of a P2Y12 antagonist is given as PT in NSTE-ACS. MethodsA retrospective analysis was carried out of patients admitted with NSTE-ACS included in the Portuguese Registry of Acute Coronary Syndromes between 2015 and 2019. Patients undergoing PT were excluded. Patients were divided into two groups regarding the timing of CA (<24 h vs. >24 h). Independent predictors of a composite of all-cause mortality and rehospitalization for cardiovascular causes at one year were assessed by multivariate logistic regression. ResultsA total of 619 patients were assessed, mean age 63±12 years, 77.5% male. On CA, 6.1% had normal coronary arteries, 49.6% single-vessel disease and 44.8% multivessel disease. Revascularization was performed in 88.6%. Pending CA, 66.0% were medicated with ticagrelor and 42.3% with clopidogrel. Adverse in-hospital outcomes were not significantly different between groups, except for more major bleeding in the DS group. The one-year composite endpoint of total mortality and cardiovascular rehospitalization occurred in 8.9%, with no difference between groups. ConclusionIn patients with NSTE-ACS in the absence of PT with a P2Y12 antagonist, an early invasive strategy was not associated with more in-hospital adverse outcomes or a reduction of total mortality and rehospitalization for cardiovascular causes at one year.

Beyond Thermal Sensation: Roles of Transient Receptor Potential Vanilloid Subfamily Member 1 and Spicy Food in Cardiometabolic Diseases

Beyond Thermal Sensation: Roles of Transient Receptor Potential Vanilloid Subfamily Member 1 and Spicy Food in Cardiometabolic Diseases

Anti-Remodeling Cardiac Therapy in Patients With Duchenne Muscular Dystrophy, Meta-Analysis Study.

Background: Almost all Duchenne muscular dystrophy (DMD) patients that reach their 30s present cardiomyopathy. As a result, this population remains under-treated. There is no sufficient proof of the efficacy of anti-remodeling cardiac therapy for DMD cardiomyopathy (DMDCM). We aim to assess the efficacy of anti-remodeling cardiac therapy for DMDCM by using meta-analysis. Methods: PubMed (MEDLINE), Embase, and Cochrane library were searched through January 2021. Randomized control trials, case-control studies, and observational studies that reported assessments of cardiovascular outcomes and death of participants using angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, mineralocorticoid-receptor antagonists and Ivabradine, were included. The primary outcome was total mortality. Secondary outcomes included changes in left ventricular ejection fraction (LVEF), serum natriuretic peptide levels (BNP), and heart rate (HR). Data were extracted for eligibility by two independent reviewers. Random-effects meta-analysis was used to pool results. Results: Twelve studies with 439 patients were included in our meta-analysis. Treated patients have lower HR, mean difference of −17 beats per minute (CI [−25]–[−9], p < 0.01). The LVEF was improved in treated patients, with a mean difference of LVEF of 3.77% (CI 0.44–7.12, p < 0.03). Although mortality rates did not reach statistical significance there was a trend for total mortality reduction (hazard ratio 0.36, CI (0.1–1.25), p = 0.107) and for BNP reduction (SSMD: 0.141, CI ([−0.19]–[0.47]), p = 0.3). Conclusion: Pharmacologic treatment for DMDCM patients is associated with decreased HR and improved LVEF. Therefore, DMDCM patients may benefit from implementing guideline therapy for HF.

Shifting the focus of d-glucosamine from a dietary supplement for knee osteoarthritis to a potential anti-aging drug

d -Glucosamine is a protective dietary supplement or medicine for osteoarthritis of the knee, a musculoskeletal disease that leads to a significant deterioration in daily activities and quality of life. As glucosamine can restore damaged cartilage worn down by joint disease, there was hope it could also improve symptoms. Data from several clinical studies on the efficacy of glucosamine on knee joint function conducted since the 1980s have been used in certain meta-analyses and epidemiological studies since 2010, yet the effect of glucosamine on the knee joints remains controversial. Concurrently, many drugs have been investigated for their anti-aging properties. Among these drugs, glucosamine has recently been discovered to be a potential substance with convincing evidence for increasing human lifespan. More interestingly, Zhi-Hao et al. have recently reported that the use of glucosamine was associated with a reduction in total mortality regardless of its effect on the knee (Annals of the Rheumatic Diseases 79(2020)829–836). Additionally, glucosamine prolongs the lifespan of the nematode Caenorhabditis elegans , possibly due to its calorie restriction-mimicking effect by improving energy metabolism and inducing autophagy. Thus, the recent large-scale epidemiological report on glucosamine intake and mortality, as well as our animal studies (Journal of Applied Glycoscience 65(2018)37–43), has become relevant. However, the potential significance of metabolism of glucosamine in anti-aging should be more clearly investigated in the future. This paper presents the novel concept of repositioning glucosamine from a dietary supplement or an OTC drug for osteoarthritis improvements to an anti-aging drug for healthy lifespan extension. • Glucosamine has been conventionally proposed as a protective dietary supplement or medicine for osteoarthritis of the knee. • A recent meta-analysis has reported a small positive effect for glucosamine on osteoarthritis. • There are new epidemiological reports on the effects of glucosamine regarding low mortality. • The mechanism underlying the effects of these drugs is expected to involve a calorie restriction-mimicking effect by improving energy metabolism and inducing autophagy. • The drug repositioning of glucosamine as from osteoarthritis to antiaging dietary supplement could have been expected.

Assessment of Novel Water Applied Prebiotic to Evaluate Gut Barrier Failure and Performance in Two Commercial Trials in Brazil. A Pilot Study With an Economic Perspective.

The present study evaluated the effect of administration of a water applied prebiotic on gut barrier failure (Experiment 1) and performance in broiler chickens under commercial conditions (Experiment 2). Experiment 1, one thousand four hundred and forty day-of-hatch Ross broiler chickens were assigned to one of two experimental groups (n = 30 replicate pens/treatment; n = 24 chicks/pen). Birds in the treated group received the prebiotic orally in the drinking water (0.2ml/bird) on days 3 and 17 of age. The second group served as the untreated control group. On d 18, intestinal samples were analyzed by qRT-PCR to determine the expression of MUC2, IL-8, TGF-β4, and ZO-1. On d 17, d 28, and d 35 blood samples were collected to determine circulating endotoxin levels. On d 28, mucosal intestinal scrapping was collected to measure relative total sIgA levels. At d 42, liver samples were collected to evaluate liver bacterial translocation. In Experiment 2, the prebiotic was evaluated in two commercial trials. Chickens were raised under normal production conditions and fed a 3-phase commercial basal diet with enramycin (7 g/ton). In Trial 1, 8,974,237 broiler chickens were treated with the prebiotic. The prebiotic was administered in the drinking water (0.2 mL/bird) following the manufacture label instructions at day three and seventeen of life. Production parameters were compared to historical information from the company over the same broiler operation and production cycles. For trial 2, 921,411 broiler chickens were treated with the prebiotic as in Trial 1. In Experiment 1, treated chickens showed a significant (P < 0.05) increase in mRNA expression of MUC2, TGF-β4, IL-8, ZO-1, and sIgA, but a significant reduction of serum endotoxin levels and incidence of liver lactose positive bacterial translocation when compared to non-treated chickens. In both trials of Experiment 2, a significant reduction in total mortality was observed in the treated chickens when compared with the historical farm data. Economic analysis utilizing the total percent of mortality revealed a $1: $2.50 USD and $1: $4.17 USD return for Trial 1 and Trial 2, respectively. The results suggest that the prebiotic positively influences gastrointestinal integrity and performance.

Improved COVID-19 ICU admission and mortality outcomes following treatment with statins: a systematic review and meta-analysis.

IntroductionApproximately 1% of the world population has now been infected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19). With cases still rising and vaccines just beginning to rollout, we are still several months away from seeing reductions in daily case numbers, hospitalisations, and mortality. Therefore, there is a still an urgent need to control the disease spread by repurposing existing therapeutics. Owing to antiviral, anti-inflammatory, immunomodulatory, and cardioprotective actions, statin therapy has been considered as a plausible approach to improve COVID-19 outcomes.Material and methodsWe carried out a meta-analysis to investigate the effect of statins on 3 COVID-19 outcomes: intensive care unit (ICU) admission, tracheal intubation, and death. We systematically searched the PubMed, Web of Science, Scopus, and ProQuest databases using keywords related to our aims up to November 2, 2020. All published observational studies and randomised clinical trials on COVID-19 and statins were retrieved. Statistical analysis with random effects modelling was performed using STATA16 software.ResultsThe final selected studies (n = 24 studies; 32,715 patients) showed significant reductions in ICU admission (OR = 0.78, 95% CI: 0.58–1.06; n = 10; I2 = 58.5%) and death (OR = 0.70, 95% CI: 0.55–0.88; n = 21; I2 = 82.5%) outcomes, with no significant effect on tracheal intubation (OR = 0.79; 95% CI: 0.57–1.11; n = 7; I2= 89.0%). Furthermore, subgroup analysis suggested that death was reduced further by in-hospital application of stains (OR = 0.40, 95% CI: 0.22–0.73, n = 3; I2 = 82.5%), compared with pre-hospital use (OR = 0.77, 95% CI: 0.60–0.98, n = 18; I2 = 81.8%).ConclusionsThese findings call attention to the need for systematic clinical studies to assess both pre- and in-hospital use of statins as a potential means of reducing COVID-19 disease severity, particularly in terms of reduction of ICU admission and total mortality reduction.

Опыт Татарстана по снижению смертности в рамках национального проекта «Здравоохранение» на примере проекта курации районных больниц

The article analyzes the experience of organizational and methodological work of the ICDC project office on the supervision of health care facilities in the municipal entities of the Republic of Tatarstan in 2019 within the framework of the National Project “Health Care”. The structure of the project office is presented and the areas of its activity are described. It is noted that to date there is a deficit of managerial competence among healthcare leaders. The methodology of managerial competence development based on the cycle of D. Kolb is proposed. The results of the questionnaire survey of managers of the supervised organizations are presented. The conclusion is drawn that the chosen work of ICDC permits a constructive sharing of best practices between the managers of district hospitals and gives them an opportunity to reflect on the attained results, which overall led to the development of managerial competence and reduction of total mortality in supervised districts in 2019 by an average of 8%. Conducted correlation analysis of the questionnaire results has shown that in order to decrease mortality, it is important for the manager to take a fresh look at the problem of mortality reduction and set priorities in the activities of his subordinate employees. According to the respondents, a fresh view emerges in the course of cooperative interaction and exchange of opinions between the managers and employees of the organization participating in this mortality reduction project.

Co dla kardiologa oznacza badanie EMPA-REG Outcome?

Most of the currently used drugs in diabetes reduce only the risk of macrovascular complications. This effects in only a small reduction of total mortality. The article describes empagliflozin – the first drug that reduces total mortality in diabetic patients with high cardiovascular risk.

Complete revascularization for patients with multivessel coronary artery disease and ST-segment elevation myocardial infarction after the COMPLETE trial: a meta-analysis of randomized controlled trial

Abstract Background The recently published COMPLETE trial has demonstrated that patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD), who underwent successful percutaneous coronary intervention (PCI) of both culprit and non-culprit (vs. culprit-only) lesion had a reduced risk of major adverse cardiac events (MACE: cardiovascular mortality, myocardial infarction, or ischemia-driven revascularization), but not of cardiovascular or total mortality. Aim To assess the efficacy of complete revascularization for cardiovascular or total mortality reduction by meta-analysis of all available randomized controlled trials (RCTs) including the COMPLETE trial. Methods PubMed, MEDLINE, Embase, Scopus, Google Scholar, CENTRAL and ClinicalTrials.gov databases search identified 10 RCTs of 7033 patients with STEMI and MVD which compared complete (n=3420) vs. only culprit lesion (n=3613) PCI for a median 28.7 months follow-up. Random effect risk ratios were used for efficacy and safety outcomes. Results Complete revascularization reduced the risk of MACE (10.4% vs. 16.6%; RR=0.59, 95% CI: 0.47 to 0.74, p&amp;lt;0.0001), CV mortality (2.87% vs. 3.72%; RR=0.73, 95% CI: 0.56 to 0.95, p=0.02), reinfarction (5.1% vs. 7.1%; RR=0.67, 95% CI: 0.52 to 0.86, p=0.002), urgent revascularization (7.92% vs. 17.4%; RR=0.47, 95% CI: 0.30 to 0.73, p&amp;lt;0.001), and CV hospitalization (8.68% vs. 11.4%; RR=0.65, 95% CI: 0.44to 0.96, p=0.03) compared with culprit only revascularization. All-cause mortality, stroke, major bleeding events, or contrast induced nephropathy were not affected by the revascularization strategy. Conclusion The findings of this meta-analysis suggest that in patients with STEMI and MVD, complete revascularization is superior to culprit-only PCI in reducing the risk of MACE outcomes, including cardiovascular mortality, without increasing the risk of adverse safety outcomes. Funding Acknowledgement Type of funding source: None

Complete revascularization for patients with multivessel coronary artery disease and ST-segment elevation myocardial infarction after the COMPLETE trial: A meta-analysis of randomized controlled trials.

BackgroundThe recently published COMPLETE trial has demonstrated that patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD), who underwent successful percutaneous coronary intervention (PCI) of both culprit and non-culprit (vs. culprit-only) lesions had a reduced risk of major adverse cardiac events (MACE), but not of cardiovascular or total mortality. The aim of this meta-analysis was to assess the efficacy of complete revascularization on cardiovascular or total mortality reduction using available randomized controlled trials (RCTs) including the COMPLETE trial, in hemodynamically stable STEMI patients with MVD.MethodsPubMed, MEDLINE, Embase, Scopus, Google Scholar, CENTRAL and ClinicalTrials.gov databases search identified 10 RCTs of 7033 patients with STEMI and MVD which compared complete (n = 3420) vs. only culprit lesion (n = 3613) PCI for a median 27.7 months follow-up. Random effect risk ratios were used to estimate for efficacy and safety outcomes.ResultsComplete revascularization reduced the risk of MACE (10.4% vs.16.6%; RR = 0.59, 95% CI: 0.47 to 0.74, p < 0.0001), CV mortality (2.87% vs. 3.72%; RR = 0.73, 95% CI: 0.56 to 0.95, p = 0.02), reinfarction (5.1% vs. 7.1%; RR = 0.67, 95% CI: 0.52 to 0.86, p = 0.002), urgent revascularization (7.92% vs.17.4%; RR = 0.47, 95% CI: 0.30 to 0.73, p < 0.001), and CV hospitalization (8.68% vs.11.4%; RR = 0.65, 95% CI: 0.44to 0.96, p = 0.03) compared with culprit only revascularization. All-cause mortality, stroke, major bleeding events, or contrast induced nephropathy were not affected by the revascularization strategy.ConclusionThe findings of this meta-analysis suggest that in patients with STEMI and MVD, complete revascularization is superior to culprit-only PCI in reducing the risk of MACE outcomes, including cardiovascular mortality, without increasing the risk of adverse safety outcomes.

154 Blood Pressure Target in Management of Postural Hypotension in Elderly: Evidence Free Zone?

Abstract Optimizing of polypharmacy in the elderly patient presenting with falls requires making judgement calls between stopping or reducing anti-hypertensives with the increased risk of stroke and cardiovascular disease versus continuing the medications with the consequent orthostatic hypotension, electrolyte abnormalities and worsening of cognition due to reduced perfusion pressure in patients with dementia. The trial evidence in this cohort of patients is scant and conflicting. The Milan 75+ Cohort study published in Age and Ageing, Volume 44, Nov. 2015 by Giulia Ogliari et al showed a U shaped relationship between BP and mortality with the lowest mortality at systolic blood pressure of 165 mm Hg. The Hypertension in the Very Elderly Trial (HYVET) published in New England Journal of Medicine in March 2008 by Nigel S Beckett et al showed reduction in any cause death by 21% in the intensive treatment group, while the Cochrane Systematic Review by Vijaya M Musini et al published in 2009 showed no reduction in total mortality in the very elderly patient with increased withdrawals due to adverse effects in the treatment group. There are questions on the applicability of trial evidence with the HYVET trial having lower level of patients with diabetes and cardiovascular disease and the SPRINT trial including mainly younger patients with good baseline renal function and little cardiovascular disease. The combination of frailty showed improved outcome in HYVET but had no effect in SPRINT trial. The number needed to treat to avoid one significant event in patients with a blood pressure of &amp;gt;170 is 125 for death, 67 for stroke and 48 for heart failure. In this context issues such as patient preference, degree of frailty, cognitive impairment, and life expectancy have to be taken in account before deciding on the suggested treatment for the individual patient.

P5714Impact on the prognosis of treatment administrated in the daily clinical practice to patients with myocardial infarction with non-obstructive coronary arteries

Abstract Background Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) remains a challenge in cardiology clinical practice. 2016 European Society of Cardiology Working Group position paper (ESC-WGPP) recommend to treat them as the rest of myocardial infarctions, mainly with dual antiplatelet therapy (DAT), beta blockers, Angiotensin Converter Enzyme Inhibitors (ACEI), and statins. The aim of this study is to analyse the use of optimal medical treatment (OMT) of ischemic heart disease (IHD) treatment on this group of patients and its implication in their prognosis. Methods Analytical and observational study based on a retrospective cohort of MINOCA (according to the definitions of ESC-WGPP) extracted from the myocardial infarction registries of three University Hospitals during the period from 2003–2018 (N: 9371). We analysed data about the treatment of all consecutive MINOCA. Treatment prescribed was the one considered by their responsible doctors. We recorded specific information about treatment prescribed after hospitalization. Follow up analysis based on Cox regression included death from any cause and major adverse cardiovascular events ([MACE], a composite of a recurrence of myocardial infarction, stroke or transient ischemic attack or death from any cardiovascular cause) Median follow up was 52.6±32.5 months. Results Of 9371 patients initially admitted for acute myocardial infarction, 620 were classified as MINOCA (incidence 6.6%). Median age was 64.2 years old, and 40.7% were women. Regarding cardiovascular risk factors, 25.1% were smokers, 19.0% had diabetes, 42.3 had dyslipidemia and 57.7% hypertension. At discharge, 18.2% had ventricular dysfunction. DAT was prescribed in 32.4% of MINOCA patients, beta blockers in 59.5%, ACEI in 54.8% and statins in 71.9%. Statins showed impact on MINOCAs prognosis, with a significant reduction in total mortality Hazard Ratio (HR): 0.60 (95%Confidence Interval [CI]: 0.38–0.94) p 0.03. DAT had a non-significant reduction in total mortality (HR 0.64 [CI: 0.37–1.13] p 0.12). The rest of the OMT of IHD showed no significant impact on total mortality: beta blockers (HR 0.84 [CI: 0.54–1.31] p 0.45) and ACEI (1.30 [CI: 0.83–2.03] p 0.25) None of the OMT had impact on MACE after MINOCA: DAT (HR 0.97 [CI: 0.70–1.35] p 0.87), beta blockers (HR 0.92 [CI: 0.69–1.23] p 0.57), ACEI (1.13 [CI: 0.85–1.51] p 0.40) and statins (0.94 [CI: 0.69–1.30] p 0.74). Figure 1 Conclusion This study suggests that statins may be liked with a better prognosis in MINOCA, whereas the rest of conventional IHD treatments showed no difference in the course of the illness. This could be due to the heterogeneity of physiopathological mechanisms underlying the working diagnosis of MINOCA. So, following the 2016 ESC-WGPP on MINOCA recommendations, a deep diagnostic study must be performed in order to individualize the treatment.

Meta-analysis of Randomized Controlled Trials Assessing the Impact of Proprotein Convertase Subtilisin/Kexin Type 9 Antibodies on Mortality and Cardiovascular Outcomes

Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition by monoclonal antibodies has been shown to reduce low density lipoprotein (LDL-C) but its effects on cardiovascular (CV) outcomes have not been fully described. The aim of this study is to assess the impact of PCSK9 inhibition on mortality and CV outcomes by pooling data from all available randomized clinical trials (RCT) of PCSK9 inhibitors. We conducted a comprehensive search of electronic databases, up to December 1, 2018, for all RCTs comparing PCSK9 inhibition to placebo or ezetimibe in patients with hypercholesterolemia or coronary artery disease receiving maximally tolerated statin for primary or secondary prevention of mortality and cardiovascular outcomes. We used random-effects meta-analyses to summarize the studies. We retained 23 RCTs having included 88,041 patients in primary and secondary prevention. The follow-up ranged from 6 to 36 months. PCSK9 inhibition was not significantly associated with reductions in total mortality (odds ratio [OR] 0.91, 95% confidence interval [CI] 078 to 1.06; p = 0.22) and CV mortality (OR 0.95, 95% CI 0.84 to 1.07; p = 0.37). In contrast, PCSK9 inhibition was associated with reductions in myocardial infarction (OR 0.80, 95% CI 0.71 to 0.91; p <0.0001), stroke (OR 0.75, 95% CI 0.65 to 0.85; p <0.0001), and coronary revascularization (OR 0.82, 95% CI 0.77 to 0.88; p <0.0001). In conclusion, PCSK9 inhibition was associated with reductions in myocardial infarction, stroke, and coronary revascularization. Future analyses may identify high-risk patients who may benefit more from these agents and longer follow-up of current or new trials may show a mortality benefit.

Effect of lithium on suicide and mortality in mood disorders: A systematic review.

To assess if lithium treatment in patients with mood disorders, for instance depression, bipolar disorders, and schizoaffective disorders, has an effect on total mortality and suicide. Systematic review and meta-analysis. Total mortality. Secondary outcome was suicide. PubMed and ClinicalTrials.gov. Eligible trials were randomized double-blind trials comparing lithium with placebo in patients with mood disorders who were not already on lithium before randomization in order to avoid withdrawal effects in the placebo group. Two researchers extracted data independently. Data were analysed with Review Manager 5.3 (Peto odds ratio). We found 45 eligible studies. Only four studies reported any suicides or other deaths in the lithium or placebo group. There was a significant reduction in total mortality (two versus nine), odds ratio 0.28 (95% confidence interval 0.08 to 0.93). There was no statistically significant reduction in suicides, (none versus three), odds ratio 0.13 (0.01 to 1.27). According to our study, lithium reduces total mortality in mood disorders but not suicide. Because of small numbers and unreliable data, the findings should be interpreted with caution.

Does the temporary decrease in the estimated glomerular filtration rate (eGFR) after initiation of mineralocorticoid receptor (MR) antagonist treatment lead to a long-term renal protective effect?

Recently, deleterious effects of aldosterone on the kidney via mineralocorticoid receptors (MRs) have been noted. MR antagonists have been reported to show significant antialbuminuric effects when added to angiotensin-converting enzyme inhibitors or angiotensin II type 1 receptor blockers. However, a decrease in the estimated glomerular filtration rate (eGFR) has been reported during MR antagonist treatment. On the other hand, although the eGFR often decreases, significant reductions in total mortality and cardiovascular events have been observed in large-scale clinical trials in patients with chronic heart failure. What are the implications of the changes in eGFR due to MR antagonist treatment? Glomerular hyperfiltration has been reported to occur with an aldosterone excess, and it can be seen that relative glomerular hyperfiltration is rapidly corrected with MR antagonism, even without aldosterone excess. This is reflected in the initial temporary decrease in the eGFR. After MR antagonist treatment, eGFR decreases temporarily, and it appears that renal function has deteriorated. However, if renal function has actually deteriorated, a reduction in all-cause and cardiovascular death is unlikely to occur in the clinical studies in patients with chronic heart failure. That is, the initial transient decrease in eGFR by the MR antagonist appears to work effectively to provide fine adjustment of glomerular pressure, and this approach works advantageously to suppress long-term cardiovascular events. It is expected that a number of long-term, large-scale clinical research trials targeting renal events and all-cause and cardiovascular death in CKD patients treated with an MR antagonist will be planned.

When is an implantable cardioverter-defibrillator controversial?

When is an implantable cardioverter-defibrillator controversial?