Impact of periprocedural myocardial injury after transcatheter aortic valve implantation on long-term mortality: a meta-analysis of Kaplan-Meier derived individual patient data.

Background: Periprocedural myocardial injury (PPMI) frequently occurs after transcatheter aortic valve implantation (TAVI), although its impact on long-term mortality is uncertain. Methods: We performed a pooled analysis of Kaplan-Meier-derived individual patient data to compare survival in patients with and without PPMI after TAVI. Flexible parametric models with B-splines and landmark analyses were used to determine PPMI prognostic value. Subgroup analyses for VARC-2, troponin, and creatine kinase-MB (CK-MB)-defined PPMI were also performed. Results: Eighteen observational studies comprising 10,094 subjects were included. PPMI was associated with lower overall survival (OS) after two years (HR = 1.46, 95% CI 1.30-1.65, p < 0.01). This was also observed when restricting the analysis to overall VARC-2-defined PPMI (HR = 1.23, 95% CI 1.07-1.40, p < 0.01). For VARC-2 PPMI criteria and VARC-2 troponin-only, higher mortality was restricted to the first 2 months after TAVI (HR = 1.64, 95% CI 1.31-2.07, p < 0.01; and HR = 1.32, 95% CI 1.05-1.67, p = 0.02, respectively), while for VARC-2 defined CK-MB-only the increase in mortality was confined to the first 30 days (HR = 7.44, 95% CI 4.76-11.66, p < 0.01). Conclusion: PPMI following TAVI was associated with lower overall survival compared with patients without PPMI. PPMI prognostic impact is restricted to the initial months after the procedure. The analyses were consistent for VARC-2 criteria and for both biomarkers, yet CK-MB was a stronger prognostic marker of mortality than troponin.

Angiotensin Receptor-Neprilysin Inhibitor Effects on Atherosclerotic Cardiovascular Disease Events: A Meta-Analysis of Randomized Controlled Trials.

Sacubitril-valsartan is an angiotensin receptor-neprilysin inhibitor (ARNI) associated with a decreased risk of death and hospitalization for selected patients with heart failure (HF). However, its association with improved atherosclerotic cardiovascular disease (ASCVD) events remains unclear. We performed a meta-analysis to evaluate the association of ARNI with ASCVD events in patients with HF. We systematically searched PubMed, Embase, Cochrane, and ClinicalTrials.gov for studies comparing ARNIs with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) in terms of myocardial infarction, stroke, angina pectoris, peripheral artery disease, and the composite end point in patients with HF. A total of 8 randomized controlled trials were included, with 17,541 patients assigned to either the ARNI (8,764 patients) or ACEi/ARB (8,777 patients) groups. The incidence of composite end point (risk ratio [RR] 1.03, 95% confidence interval [CI] 0.93 to 1.13, p = 0.63), myocardial infarction (RR 1.02, 95% CI 0.81 to 1.30, p = 0.85), angina pectoris (RR 0.96, 95% CI 0.80 to 1.17, p = 0.70), and stroke (RR 0.99, 95% CI 0.85 to 1.16, p = 0.93) were not statistically different between the ARNI and ACEi/ARB groups. However, ARNI was associated with a higher incidence of peripheral artery disease (RR 1.63, 95% CI 1.05 to 2.52, p = 0.03). In conclusion, this meta-analysis found no association between ARNI therapy and improved ASCVD events in patients with HF.

Desafios na Atividade Laboral de Pacientes em Hemodiálise e sua Associação com a Qualidade de Vida / Work Activity Challenges among Hemodialysis Patients and Their Impact on Quality of Life

Grande parte dos pacientes em hemodiálise estão em idade laboral, acarretando um desafio na manutenção do seu trabalho. Realizou-se um estudo transversal em centros de hemodiálise no norte de Santa Catarina, entre dezembro de 2020 a fevereiro de 2021. Incluiu-se pacientes entre 18 e 55 anos em hemodiálise há mais de 3 meses. Avaliou-se aspectos relacionados ao trabalho, sua manutenção após início da hemodiálise e a qualidade de vida através do instrumento SF-36. A condição laboral foi avaliada com relação a qualidade de vida através de regressão logística. Dos 108 pacientes, a média de idade foi 43,34 ±8,88 anos, com mediana do tempo em diálise de 19 meses. Dos participantes, 78,9% estavam trabalhando seis meses antes do início da hemodiálise e 39,8% após 6 meses. Não houve diferença em relação ao sexo, idade e estado civil com relação ao trabalho antes ou após 6 meses do início da hemodiálise. Trabalhar foi associado a uma maior qualidade de vida, mesmo após ajuste para outras variáveis (OR=5,30; 95% IC 1,43-19,61, p=0,013). Conclui-se que existe importante queda da manutenção do emprego após início da hemodiálise. O estímulo a manutenção do trabalho pode favorecer uma melhor qualidade de vida nestes pacientes.

Most patients undergoing hemodialysis are of working age, and this poses a challenge in maintaining their jobs. A crosssectional study was carried out in hemodialysis centers in the north of Santa Catarina, between December 2020 and February 2021. Patients aged between 18 and 55 years old on hemodialysis for more than 3 months were included. Aspects related to work, remaining at their job after starting hemodialysis, and quality of life were evaluated using the SF-36 instrument. Their working situation was evaluated in relation to quality of life through logistic regression. Of the 108 patients, the mean age was 43.34 ± 8.88 years old, with a median time on dialysis of 19 months. Of the participants, 78.9% were working six months before starting hemodialysis and 39.8% were working 6 months after. There was no difference in terms of sex, age, and marital status with regards to work before or after 6 months of starting hemodialysis. Working was associated with a better quality of life, even after adjusting for other variables (OR=5.30; 95% CI 1.43-19.61, p=0.013). It is concluded that there is a significant drop in employment after starting hemodialysis. The stimulus to keep working can favor a better quality of life in these patients.

Once-Weekly Insulin Icodec vs. Once-Daily Insulin Glargine U100 for type 2 diabetes: a systematic review and meta-analysis of phase 2 randomized controlled trials

ABSTRACT Objective: Insulin Icodec is a novel basal insulin analogue designed for once-weekly administration, therefore might propitiate reduction in the frequency of injections and facilitate treatment adherence. This study aimed to determine the glycemic control and safety profile of Insulin Icodec, compared with Glargine U100 in patients with diabetes mellitus type 2. Materials and methods: We performed a systematic review and meta-analysis of randomized controlled trials (RCT) data comparing Once-Weekly Insulin Icodec and Once-Daily Insulin Glargine U100 in patients with type 2 diabetes mellitus. PubMed, Embase, and Cochrane databases were searched for trials published up to May 14, 2022. Data were extracted from published reports and quality assessment was performed per Cochrane recommendations. Results: Three studies were included comprising 453 patients, 230 (50.77%) using Once-Weekly Insulin Icodec and 223 (49.22%) using Once-Daily Insulin Glargine U100. In the pooled data, Glycated Hemoglobin (MD -0.20% CI -0.33 to -0.07%; P=0.002) change from baseline demonstrated a significantly higher reduction in the Icodec group. Time with Glucose in Range (MD 6.60% CI 3.63 to 9.57%; P < 0.0001) and Insulin Dose Difference (MD 0.97UI CI 0.76 to 1.18UI; P < 0.0001) were higher in the Icodec group. There was no significant difference in fasting plasma glucose, body weight change, hypoglycemia or any adverse event evaluated. Conclusions: Once-Weekly Insulin Icodec was associated with a small reduction in Glycated Hemoglobin, as well as higher Time with Glucose in Range, with similar hypoglycemic adverse events, when compared with Once-Daily Insulin Glargine U100.