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Circulation. Cardiovascular Imaging Nov 2023The efficacy of coronary computed tomography angiography (CCTA) versus invasive coronary angiography (ICA) among patients with stable chest pain has been studied in... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The efficacy of coronary computed tomography angiography (CCTA) versus invasive coronary angiography (ICA) among patients with stable chest pain has been studied in several trials with conflicting results.
METHODS
We performed a systematic review and meta-analysis comparing CCTA first versus direct ICA among patients with stable chest pain, who were initially referred to ICA. PubMed, EMBASE, and Cochrane Central were searched for randomized controlled trials comparing the 2 strategies. Risk ratios (RRs) and mean differences with 95% CIs were computed for binary and continuous outcomes, respectively.
RESULTS
Five randomized controlled trials with a total of 5727 patients were included, of whom 51.1% were referred to CCTA and 22.5% of patients had evidence of ischemia on a prior functional test. In the follow-up ranging from 1 to 3.5 years, 660 of the 2928 patients randomized to CCTA first underwent ICA (23%). Patients who underwent CCTA had lower rates of coronary revascularization (RR, 0.74 [95% CI, 0.66-0.84]; <0.001) and stroke (RR, 0.50 [95% CI, 0.26-0.98]; =0.043). Cardiovascular mortality (RR, 0.55 [95% CI, 0.24-1.23]; =0.146), major adverse cardiovascular events (RR, 0.84 [95% CI, 0.64-1.10]; =0.198), nonfatal myocardial infarction (RR, 1.09 [95% CI, 0.63-1.88]; =0.768), and cardiovascular hospitalizations (RR, 0.91 [95% CI, 0.59-1.39]; =0.669) did not differ significantly between groups.
CONCLUSIONS
In patients with stable chest pain referred for ICA, CCTA avoided the need for ICA in 77% of patients otherwise referred for ICA. CCTA was associated with a reduction in the rates of coronary revascularization and stroke compared with direct ICA.
REGISTRATION
URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42023383143.
Topics: Humans; Computed Tomography Angiography; Coronary Artery Disease; Coronary Angiography; Randomized Controlled Trials as Topic; Chest Pain; Stroke
PubMed: 37988448
DOI: 10.1161/CIRCIMAGING.123.015800 -
Journal of Vascular Surgery May 2022Chronic limb-threatening ischemia (CLTI) causes significant morbidity with profound negative effects on health-related quality of life. As the prevalence of peripheral... (Review)
Review
Chronic limb-threatening ischemia (CLTI) causes significant morbidity with profound negative effects on health-related quality of life. As the prevalence of peripheral artery disease and diabetes continue to rise in our aging population, the public health impact of CLTI has escalated. Patient-reported outcome measures (PROMs) have become common and important measures for clinical evaluation in both clinical care and research. PROMs are important for the measurement of clinical effectiveness and cost effectiveness and for shared decision-making on treatment options. However, the PROMs used to describe the experience of patients with CLTI are heterogeneous, incomplete, and lack specific applicability to the underlying disease processes and diverse populations. For example, certain PROMs exist for patients with extremity wounds, and other PROMs exist for patients with pain, and still others exist for patients with vascular disease. Despite this multiplicity of tools, no single PROM encompasses all of the components necessary to describe the experiences of patients with CLTI. This significant unmet need is evident from both published reports and contemporary large-scale clinical trials in the field. In this systematic review, we review the current use of PROMs for patients with CLTI in clinical practice and in research trials and highlight the gaps that need to be addressed to develop a unifying PROM instrument for CLTI.
Topics: Aged; Amputation, Surgical; Chronic Disease; Chronic Limb-Threatening Ischemia; Humans; Ischemia; Limb Salvage; Patient Reported Outcome Measures; Peripheral Arterial Disease; Quality of Life; Retrospective Studies; Risk Factors; Treatment Outcome
PubMed: 35085747
DOI: 10.1016/j.jvs.2021.11.057 -
Current Problems in Cardiology Oct 2022Familial hypercholesterolemia (FH) is the most common genetic disease which accelerates the development of premature coronary artery disease (CAD) in young adults if... (Review)
Review
Familial hypercholesterolemia (FH) is the most common genetic disease which accelerates the development of premature coronary artery disease (CAD) in young adults if remains untreated. The overall prevalence of FH is currently unknown and is usually underdiagnosed and undertreated worldwide. FH registry in different geographical area is a mission that helps early diagnosis of FH patients in the general population. PubMed, ISI Web of Science, Scopus, and Google Scholar were searched systematically for studies and reports on the FH registry using related keywords. Finally, 27 studies were included in this review. Most of the studies used the CASCADE screening method based on 1 or more than 1 of the 3 well-established FH criteria namely, the Dutch Lipid Clinic Network, Simon Broome Register, or Make Early Diagnosis to Prevent Early Death criteria. Except for a small number of studies that the genetic and molecular methods were used, in other studies only clinical diagnosis was applied. All these studies claimed that the FH registry causes the identification of many new cases as a result of used CASCADE screening and referral to lipid clinics. They concluded that the FH registry increases general and also physician awareness on FH prevalence and its related complications which in the long-term will improve FH management. This indicates that in other parts of the world, the FH registry should be established as well so that more accurate statistics on the prevalence of this disease can be found worldwide which would help in diagnosis and prevention.
Topics: Coronary Artery Disease; Humans; Hyperlipoproteinemia Type II; Lipids; Prevalence; Registries; Young Adult
PubMed: 34571102
DOI: 10.1016/j.cpcardiol.2021.100999 -
Heart, Lung & Circulation Aug 2023Uptake of cardiac magnetic resonance (CMR) in Australia has been limited by issues of cost and access. There is a need to inform future application of CMR by evaluating... (Review)
Review
INTRODUCTION
Uptake of cardiac magnetic resonance (CMR) in Australia has been limited by issues of cost and access. There is a need to inform future application of CMR by evaluating pertinent health economic literature. We sought to perform a systematic review on the health economic data as it pertains to CMR.
METHODS
Eight databases (biomedical/health economic) were searched for relevant articles highlighting economic evaluations of CMR. Following screening, studies that reported health economic outcomes (e.g., dollars saved, quality adjusted life years [QALY] and cost effectiveness ratios) were included. Data on cost effectiveness, clinical/disease characteristics, type of modelling were extracted and summarised.
RESULTS
Thirty-eight (38) articles informed the systematic review. Health economic models used to determine cost effectiveness included both trial-based studies (n=14) and Markov modelling (n=24). Comparative strategies ranged from nuclear imaging, stress echocardiography and invasive angiography. The disease states examined included coronary artery disease (23/38), acute coronary syndrome (3/38), heart failure (5/38) and miscellaneous (7/38). The majority of studies (n=29/38) demonstrated CMR as a strategy which is either economically dominant, cost-effective or cost-saving.
CONCLUSION
This systematic review demonstrates that CMR is cost-effective depending on diagnostic strategy, population and disease state. The lack of standardised protocols for application of CMR, economic models used and outcomes reported limits the ability to meta-analyse the available health economic data.
Topics: Humans; Magnetic Resonance Imaging; Heart; Heart Failure; Coronary Artery Disease; Magnetic Resonance Spectroscopy
PubMed: 37479645
DOI: 10.1016/j.hlc.2023.05.002 -
Journal of Parkinson's Disease 2022The relationship between Parkinson's disease (PD) and coronary artery disease (CAD) is unclear. (Meta-Analysis)
Meta-Analysis
BACKGROUND
The relationship between Parkinson's disease (PD) and coronary artery disease (CAD) is unclear.
OBJECTIVE
This study aims to investigate whether PD and CAD are associated through systematic review and meta-analysis of observational studies.
METHODS
Electronic database search of PubMed, EMBASE, and Web of Science for observational studies published from 1 January 2010 to 1 August 2021 was conducted using terms related to PD and CAD. Unadjusted risk ratios (RR) and odds ratios (OR) of included cohort and case-control studies respectively were used to ascertain the association between PD and CAD. Study heterogeneity was evaluated using the I2 test.
RESULTS
Forty-one full-text studies were initially retrieved for eligibility assessment. Five studies that satisfied the inclusion criteria, consisting of three cohort and two case-control studies, were eventually included in this meta-analysis. The five studies enrolled 35,237 PD patients and 650,866 non-PD patients. PD and CAD were found to be significantly associated in cohort studies (RR = 2.23, 95% CI = 1.08-4.59, p = 0.03; Fig. 2), which held after sensitivity analysis (RR = 1.45, 95% CI = 1.31-1.60, p < 0.001; Fig. 3). Case-control studies found a trend towards association of PD and CAD approaching significance (OR = 1.47, 95% CI = 0.84-2.56, p = 0.18; Fig. 2).
CONCLUSION
Overall, this meta-analysis suggests that PD is associated with CAD. The underlying mechanisms, as well as the role of ethnicity and other comorbidities on the relationship between PD and CAD should be further explored.
Topics: Case-Control Studies; Coronary Artery Disease; Humans; Observational Studies as Topic; Parkinson Disease
PubMed: 35694936
DOI: 10.3233/JPD-223291 -
South African Family Practice :... Aug 2023In 2019, the World Health Organization (WHO) declared coronary artery disease (CAD) as the leading cause of death globally for the last 20 years. Early screening and... (Review)
Review
BACKGROUND
In 2019, the World Health Organization (WHO) declared coronary artery disease (CAD) as the leading cause of death globally for the last 20 years. Early screening and detection (primary prevention) and intervention (secondary prevention) are necessary to curb CAD and major adverse cardiovascular event (MACE) prevalence. A scoping review to assess the current literature on using cardiac scoring systems to predict CAD and MACE was performed.
METHODS
The research question 'What is the literature on using cardiac scoring systems to predict CAD and MACE?' was addressed. The updated Arksey and O'Malley and the Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews methodologies were used. The search terms 'coronary artery disease' and 'cardiac scoring systems' and 'major adverse cardiovascular events' were used in the Boolean search on PubMed, ScienceDirect, MedLine and Cochrane Library.
RESULTS
The final list consisted of 19 published English results after the year 2000. There were six results without participants (four clinical guidelines, one review article and one ongoing clinical trial). Scoring systems were cardiovascular risk estimation systems focusing on the primary prevention of CAD; MACE was discussed but not scored. There were 13 robust results published from completed multinational clinical trials with participants. These results focused on a scoring system for the secondary prevention of CAD and MACE.
CONCLUSION
Scoring systems remain an objective method for primary and secondary prevention of CAD and MACE.Contribution: Scoring systems may be helpful with clinical uncertainty or to standardise patient results for comparison in research.
Topics: Humans; Coronary Artery Disease; Clinical Decision-Making; Uncertainty; Heart; Cardiovascular System
PubMed: 37782230
DOI: 10.4102/safp.v65i1.5683 -
Journal of Vascular Surgery Mar 2021In the present systematic review and meta-analysis, we compared the short- and long-term outcomes of different harvesting and grafting techniques in patients undergoing... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
In the present systematic review and meta-analysis, we compared the short- and long-term outcomes of different harvesting and grafting techniques in patients undergoing lower extremity arterial bypass.
METHODS
We searched multiple electronic databases (up to December 1, 2019) for comparative trials investigating different harvesting and bypass grafting techniques.
RESULTS
We identified a total of 37 studies for our review. Skip incision harvesting showed a similar high primary patency rate (Peto odds ratio [OR], 0.93; 95% confidence interval [CI], 0.83-1.04; P = .20) with continuous incision harvesting and comparable low wound complication rates (relative risk, 1.55; 95% CI, 0.91-2.66; P = .11) with endoscopic harvesting. In situ bypass grafting a long-term patency similar to that of reversed grafting (Peto OR, 1.01; 95% CI, 0.75-1.37; P = .93). However, for femoropopliteal bypass, the reversed bypass grafting group had significantly lower 2-year (Peto OR, 0.63; 95% CI, 0.52-0.78; P < .001) and 5-year (Peto OR, 0.70; 95% CI, 0.50-0.98; P = .04) failure rates compared with the in situ bypass grafting group. For infrapopliteal bypass, the in situ bypass grafting group had significantly lower 1-year (Peto OR, 1.54; 95% CI, 1.04-2.28; P = .03), 2-year (Peto OR, 1.52; 95% CI, 1.15-2.02; P = .003), and 3-year (Peto OR, 2.14; 95% CI, 1.13-4.05; P = .02) failure rates.
CONCLUSIONS
Skip incision harvesting can be considered the first-line harvesting strategy. For patients undergoing femoropopliteal bypass, reversed bypass grafting seems to result in better long-term patency. In contrast, for those undergoing infrapopliteal bypass, in situ bypass grafting resulted in superior long-term patency.
Topics: Aged; Aged, 80 and over; Female; Humans; Lower Extremity; Male; Middle Aged; Peripheral Arterial Disease; Postoperative Complications; Risk Assessment; Risk Factors; Saphenous Vein; Time Factors; Tissue and Organ Harvesting; Treatment Outcome; Vascular Grafting; Vascular Patency
PubMed: 33091517
DOI: 10.1016/j.jvs.2020.10.013 -
Catheterization and Cardiovascular... Sep 2023Intracoronary imaging modalities, including intravascular ultrasound (IVUS) and optical coherence tomography (OCT), provide valuable supplemental data unavailable on... (Meta-Analysis)
Meta-Analysis
Comparison of intravascular ultrasound, optical coherence tomography, and conventional angiography-guided percutaneous coronary interventions: A systematic review, network meta-analysis, and meta-regression.
BACKGROUND
Intracoronary imaging modalities, including intravascular ultrasound (IVUS) and optical coherence tomography (OCT), provide valuable supplemental data unavailable on coronary angiography (CA) and have shown to improve clinical outcomes. We sought to compare the clinical efficacy of IVUS, OCT, and conventional CA-guided percutaneous coronary interventions (PCI).
METHODS
Frequentist and Bayesian network meta-analyses of randomized clinical trials were performed to compare clinical outcomes of PCI performed with IVUS, OCT, or CA alone.
RESULTS
A total of 28 trials comprising 12,895 patients were included. IVUS when compared with CA alone was associated with a significantly reduced risk of major adverse cardiovascular events (MACE) (risk ratio: [RR] 0.74, 95% confidence interval: [CI] 0.63-0.88), cardiac death (RR: 0.64, 95% CI: 0.43-0.94), target lesion revascularization (RR: 0.68, 95% CI: 0.57-0.80), and target vessel revascularization (RR: 0.64, 95% CI: 0.50-0.81). No differences in comparative clinical efficacy were found between IVUS and OCT. Rank probability analysis bestowed the highest probability to IVUS in ranking as the best imaging modality for all studied outcomes except for all-cause mortality.
CONCLUSION
Compared with CA, the use of IVUS in PCI guidance provides significant benefit in reducing MACE, cardiac death, and revascularization. OCT had similar outcomes to IVUS, but more dedicated studies are needed to confirm the superiority of OCT over CA.
Topics: Humans; Coronary Artery Disease; Tomography, Optical Coherence; Network Meta-Analysis; Percutaneous Coronary Intervention; Bayes Theorem; Ultrasonography, Interventional; Treatment Outcome; Coronary Angiography; Death
PubMed: 37483068
DOI: 10.1002/ccd.30784 -
Current Problems in Cardiology Oct 2022Coronary artery disease (CAD) is a risk factor for cognitive decline. The aim of this study was to systematically review recent literature on whether coronary artery... (Review)
Review
Coronary artery disease (CAD) is a risk factor for cognitive decline. The aim of this study was to systematically review recent literature on whether coronary artery revascularizations are associated to cognitive decline and dementia. Pubmed, Scopus, and CINAHL (EBSCO) were searched systematically from January 2009 to September 2020. Studies were conducted on persons with CAD undergoing coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) procedure compared to other coronary artery disease treatments, and the outcome was cognitive decline or dementia. Altogether four of the 680 reviewed articles met inclusion criteria. Results were inconsistent, and the outcome measurements heterogeneous between studies. Our findings indicate an evidence gap in the current understanding of long-term outcomes following coronary artery revascularization. However, evidence of long-term effects on cognition would complement our understanding of their benefits. There is a need for more studies on long-term cognitive outcomes after coronary artery revascularizations.
Topics: Cognitive Dysfunction; Coronary Artery Disease; Dementia; Humans; Percutaneous Coronary Intervention; Treatment Outcome
PubMed: 34363848
DOI: 10.1016/j.cpcardiol.2021.100960 -
European Journal of Vascular and... Dec 2022To assess the comparative effectiveness and temporal changes in quality of life (QoL) outcomes after revascularisation, major lower extremity amputation (MLEA), and... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To assess the comparative effectiveness and temporal changes in quality of life (QoL) outcomes after revascularisation, major lower extremity amputation (MLEA), and conservative management (CM) in chronic limb threatening ischaemia (CLTI).
DATA SOURCES
MEDLINE, Embase, PsycINFO, CINAHL, and Web of Science.
REVIEW METHODS
A systematic review and meta-analysis were performed on QoL measured by any QoL instrument in adult patients with CLTI after open surgery (OS), endovascular intervention (EVI), MLEA, or CM. Randomised controlled trials and prospective observational studies published in any language between 1 January 1990 and 21 May 2021 were included. There was a pre-specified measurement time point of six months. Random effects meta-analysis was conducted on total scores for each QoL instrument. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations approach (PROSPERO registration: CRD42021253953).
RESULTS
Fifty-five studies with 8 909 patients were included. There was significant heterogeneity in the methods used to measure QoL, and the study characteristics. In particular, 14 different QoL instruments were used with various combinations of disease specific and generic instruments within each study. A narrative summary is therefore presented. Comparative effectiveness data showed there was reasonable certainty that QoL was similar between OS and EVI at six months. Temporal outcomes suggested small to moderate improvements in QOL six months after OS and EVI compared with baseline. Limited data indicated that QoL can be maintained or slightly improved after MLEA or CM. Treatment effects were overestimated owing to small study effects, selective non-reporting, attrition, and survivorship bias.
CONCLUSION
QoL after OS and EVI appears to be similar. Revascularisation may provide modest QoL benefits, while MLEA or CM can maintain QoL. However, certainty of evidence is generally low or very low, and interpretation is hampered by significant heterogeneity. There is a need for a CLTI specific QoL instrument and methodological standardisation in QoL studies.
Topics: Humans; Quality of Life; Chronic Limb-Threatening Ischemia; Amputation, Surgical; Vascular Surgical Procedures; Conservative Treatment; Observational Studies as Topic
PubMed: 35952907
DOI: 10.1016/j.ejvs.2022.07.051