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INTRODUÇÃO: Embora a hiperglicemia tenha valor prognóstico nas doenças cardiovasculares, há poucos dados disponíveis sobre seu valor prognóstico para pacientes em choque cardiogênico. OBJETIVO: Conduzir uma revisão sistemática e metanálise para avaliar os níveis glicêmicos no momento da admissão hospitalar em pacientes com choque cardiogênico decorrente de diversas causas etiológicas. MÉTODOS: Realizamos uma revisão sistemática nas bases de dados Elsevier, PubMed e Cochrane de estudos que avaliassem o valor prognóstico de índices glicêmicos na admissão de pacientes com choque cardiogênico, sendo o desfecho primário mortalidade geral. Incluímos estudos que definiram como hiperglicemia valores de corte de 180 a 220 mg/dL. Para a análise estatística foi utilizado o RevMan 5.1.7, e a heterogeneidade foi avaliada usando estatísticas I². RESULTADOS: Um total de 7 dos 5.214 estudos foram incluídos, resultando 3.504 pacientes, com média de idade variando entre 60 e 74 anos, sendo 2.242 (64%) homens. Desses pacientes, cerca de 926 (26%) tinham o diagnóstico prévio de Diabetes Mellitus. Estes pacientes foram divididos em subgrupos conforme seu índice glicêmico na admissão, Normoglicemia (<180mg/dL) e Hiperglicemia (180-220 mg/dL). O grupo hiperglicêmico foi associado a maior mortalidade (OR 2,14; IC 95% 1,53 - 3,00; p<0.00001; I²= 53%; Figura 1). CONCLUSÃO: Nesta revisão sistemática e metanálise, valores de glicemia entre 180 a 220 mg/dL foram associados a maior risco de mortalidade em pacientes em choque cardiogênico.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Shock, Cardiogenic , Cardiovascular Diseases , Glycemic Index , Prognosis , Data Interpretation, StatisticalABSTRACT
Introdução: Evidências de estudos randomizados apoiam a revascularização completa em vez do culpado apenas para pacientes com síndrome arterial coronariana aguda (SCA) e doenças coronarianas multiarteriais. Se estes resultados se estendem a pacientes idosos, no entanto, não foi completamente explorado. Métodos: Realizamos uma revisão sistemática e meta-análise comparando os resultados clínicos de idosos (definidos como idade >;75 anos) com SCA e DMV submetidos à intervenção coronária percutânea (ICP) completa vs. parcial. Foram pesquisados PubMed, Embase e Cochrane. Calculamos razões de risco agrupadas com intervalos de confiança (IC) de 95% para preservar os dados de tempo até o evento. Resultados: Incluímos 7 estudos, dos quais 2 eram RCT e 5 eram coortes ajustadas multivariáveis, compreendendo um total de 10 147, dos quais 43,8% foram submetidos à revascularização completa. Em comparação com PCI apenas parcial, a revascularização completa foi associada a uma menor mortalidade por todas as causas (razão de risco 0,71; IC 95% 0,60-0,85; P < 0,01), mortalidade cardiovascular (razão de risco 0,64; IC 95% 0,52-0,79; P < 0,01) e infarto do miocárdio recorrente (razão de risco 0,65; IC 95% 0,50-0,85; P < 0,01). Não houve diferença significativa entre os grupos em relação ao risco de revascularizações (razão de risco 0,80; IC 95% 0,53-1,20; P = 0,28). Conclusão: Entre pacientes idosos com SCA e DAC multiarterial, a revascularização completa está associada a um menor risco de mortalidade por todas as causas, mortalidade cardiovascular e infarto do miocárdio recorrente.
Subject(s)
Humans , Aged , Acute Coronary Syndrome , Percutaneous Coronary Intervention , Myocardial Revascularization , Recurrence , Quality Indicators, Health CareABSTRACT
BACKGROUND: Chimeric antigen receptor T-cell (CAR-T) therapy has shown promise in treating hematologic malignancies, yet its potential cardiotoxic effects require thorough investigation. OBJECTIVES: We aim to conduct a systematic review and meta-analysis to examine the cardiotoxic effects of CAR-T therapy in adults with hematologic malignancies. METHODS: We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials for studies reporting cardiovascular outcomes, such as arrhythmias, heart failure, and reduced left ventricle ejection fraction (LVEF). RESULTS: Our analysis of 20 studies involving 4789 patients revealed a 19.68% incidence rate of cardiovascular events, with arrhythmias (7.70%), heart failure (5.73%), and reduced LVEF (3.86%) being the most prevalent. Troponin elevation was observed in 23.61% of patients, while NT-Pro-BNP elevation was observed in 9.4. Subgroup analysis showed higher risks in patients with pre-existing conditions, such as atrial arrhythmia (OR 3.12; p < .001), hypertension (OR 1.85; p = .002), previous heart failure (OR 3.38; p = .003), and coronary artery disease (OR 2.80; p = .003). CONCLUSION: Vigilant cardiovascular monitoring is crucial for patients undergoing CAR-T therapy to enhance safety and treatment efficacy.Novelty Statements.
Subject(s)
Arrhythmias, Cardiac , Hematologic Neoplasms , Cardiotoxicity , Receptors, Chimeric Antigen , Troponin , T-Lymphocytes , Immunotherapy, Adoptive , Heart VentriclesABSTRACT
BACKGROUND: Chimeric antigen receptor T-cell (CAR-T) therapy has shown promise in treating hematologic malignancies, yet its potential cardiotoxic effects require thorough investigation. OBJECTIVES: We aim to conduct a systematic review and meta-analysis to examine the cardiotoxic effects of CAR-T therapy in adults with hematologic malignancies. METHODS: We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials for studies reporting cardiovascular outcomes, such as arrhythmias, heart failure, and reduced left ventricle ejection fraction (LVEF). RESULTS: Our analysis of 20 studies involving 4789 patients revealed a 19.68% incidence rate of cardiovascular events, with arrhythmias (7.70%), heart failure (5.73%), and reduced LVEF (3.86%) being the most prevalent. Troponin elevation was observed in 23.61% of patients, while NT-Pro-BNP elevation was observed in 9.4. Subgroup analysis showed higher risks in patients with pre-existing conditions, such as atrial arrhythmia (OR 3.12; p < .001), hypertension (OR 1.85; p = .002), previous heart failure (OR 3.38; p = .003), and coronary artery disease (OR 2.80; p = .003). CONCLUSION: Vigilant cardiovascular monitoring is crucial for patients undergoing CAR-T therapy to enhance safety and treatment efficacy.Novelty Statements.
ABSTRACT
BACKGROUND Evidence from randomized studies support complete over culprit-only revascularization for patients with acute coronary artery syndrome (ACS) and multivessel coronary artery diseases (MVD). Whether these findings extend to elderly patients, however, has not been thoroughly explored. METHODS We conducted a systematic review and meta-analysis comparing clinical outcomes of elderly individuals (defined as age ≥75 years) with ACS and MVD submitted to complete vs partial-only percutaneous coronary intervention (PCI). PubMed, Embase, and Cochrane were searched. We computed pooled hazard ratios with 95% confidence intervals (CI) to preserve time time-to-event data. RESULTS We included 7 studies, of which 2 were RCT and 5 were multivariable adjusted cohorts, comprising a total 10 147, of whom 43.8% underwent complete revascularization. As compared with partial-only PCI, complete revascularization was associated with a lower all-cause mortality (hazard ratio 0.71; 95% CI 0.600.85; P < 0.01), cardiovascular mortality (hazard ratio 0.64; 95% CI 0.520.79; P < 0.01), and recurrent myocardial infarction (hazard ratio 0.65; 95% CI 0.500.85; P < 0.01). There was no significant difference between groups regarding the risk of revascularizations (hazard ratio 0.80; 95% CI 0.531.20; P = 0.28). CONCLUSION Among elderly patients with ACS and multivessel CAD, complete revascularization is associated with a lower risk of all-cause mortality, cardiovascular mortality, and recurrent myocardial infarction.