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Frontiers in Cardiovascular Medicine 2021To systematically appraise and synthesize evidence, we conducted an overview of systematic reviews/meta-analyses (SRs/MAs) on acupuncture for stable angina pectoris...
To systematically appraise and synthesize evidence, we conducted an overview of systematic reviews/meta-analyses (SRs/MAs) on acupuncture for stable angina pectoris (SAP). Eight databases were searched for SRs/MAs of acupuncture on SAP. The methodological quality, reporting quality, and evidence quality were evaluated by Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2), the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system, respectively. A total of seven published SRs/MAs met the inclusion criteria. According to the evaluation results of AMSTAR-2, two studies were considered as of moderate quality; the remaining five were considered as of very low quality. According to the evaluation results of the PRISMA checklist, only one study reported the checklist in its entirety, while others had reporting deficiencies. According to GRADE, a total of 18 outcome indicators extracted from the included studies were evaluated. The evidence quality was very low in three, low in three, moderate in eight, and high in four. Acupuncture may be beneficial for SAP from the currently published evidence. However, this conclusion must be interpreted cautiously due to the generally low methodological quality, reporting quality, and evidence quality of the included studies. More rigorous, more standardized and comprehensive SRs/MAs are needed to provide strong evidence for convincing conclusions.
PubMed: 34660732
DOI: 10.3389/fcvm.2021.732144 -
European Heart Journal. Quality of Care... May 2022We conducted a systematic review and meta-analysis to evaluate temporal trends in quality of life (QoL) after coronary artery bypass grafting (CABG) surgery in... (Meta-Analysis)
Meta-Analysis
AIMS
We conducted a systematic review and meta-analysis to evaluate temporal trends in quality of life (QoL) after coronary artery bypass grafting (CABG) surgery in randomized clinical trials, and a quantitative comparison from before surgery to up to 5 years after surgery.
METHODS AND RESULTS
We searched MEDLINE, CINAHL, EMBASE, Cochrane Library, and PsycINFO from 2010 to 2020 to identify studies that included the measurement of QoL in patients undergoing CABG. The primary outcome was the Seattle Angina Questionnaire (SAQ), and secondary outcomes were the 36-item Short Form Health Survey (SF-36) and EuroQol Questionnaire (EQ-5D). We pooled the means and the weighted mean differences over the follow-up period. In the meta-analysis, 2586 studies were screened and 18 full-text studies were included. There was a significant trend towards higher QoL scores from before surgery to 1 year post-operatively for the SAQ angina frequency (AF), SAQ QoL, SF-36 physical component (PC), and EQ-5D, whereas the SF-36 mental component (MC) did not improve significantly. The weighted mean differences from before surgery to 1 year after was 24 [95% confidence interval (CI): 21.6-26.4] for the SAQ AF, 31 (95% CI: 27.5-34.6) for the SAQ QoL, 9.8 (95% CI: 7.1-12.8) for the SF-36 PC, 7.1 (95% CI: 4.2-10.0) for the SF-36 MC, and 0.1 (95% CI: 0.06-0.14) for the EQ-5D. There was no evidence of publication bias or small-study effect.
CONCLUSION
CABG had both short- and long-term improvements in disease-specific QoL and generic QoL, with the largest improvement in angina frequency.
Topics: Angina Pectoris; Coronary Artery Bypass; Humans; Quality of Life; Randomized Controlled Trials as Topic; Surveys and Questionnaires
PubMed: 34643672
DOI: 10.1093/ehjqcco/qcab075 -
Evidence-based Complementary and... 2021To systematically evaluate the efficacy and safety of XFZYD for coronary heart disease (CHD). (Review)
Review
OBJECTIVE
To systematically evaluate the efficacy and safety of XFZYD for coronary heart disease (CHD).
METHODS
A comprehensive literature search of randomized controlled trials using XFZYD for CHD was conducted in 10 electronic databases from their establishment to December 20, 2020. The researchers screened the relevant trials in NoteExpress, extracted the data in duplicate independently, assessed the risk of bias in the trials using the Cochrane collaboration tool, and then used Rev Man 5.3 for data analysis.
RESULTS
30 trials with 3126 participants were included for meta-analysis. The results showed that the clinical effects of XFZYD and its combination with chemical drugs (CD) were 1.13 (RR; 1.13; 95% CI, 1.03 to 1.24) and 1.26 (RR; 1.26; 95% CI, 1.20 to 1.32) times those of CD, respectively. And, it could also improve electrocardiogram effect, which was 1.63 (RR; 1.63; 95% CI, 1.04 to 2.53) times that of CD. XFZYD could not only decrease duration of angina pectoris and improve vascular endothelial function but also obviously reduce the TCM syndrome score. When used in combination with CD, it could also lower AF, correct the dyslipidemia, and reduce the blood viscosity.
CONCLUSION
These results demonstrated that XFZYD had great advantages in treating CHD with no obvious adverse reactions. Therefore, it is believed that XFZYD is more suitable for CHD patients with clinical indicators of dyslipidemia, high blood viscosity, or vascular endothelial dysfunction. This study is the first systematic review and meta-analysis with some unique ways, including its comprehensiveness, large-scale search, the novelty of findings, and transparent approach.
PubMed: 34630621
DOI: 10.1155/2021/9931826 -
Nutrition, Metabolism, and... Oct 2021Triglyceride-Glucose (TyG) index is an accurate biomarker of insulin resistance, which is potentially associated with adverse cardiovascular events. We aimed to assess... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND AIMS
Triglyceride-Glucose (TyG) index is an accurate biomarker of insulin resistance, which is potentially associated with adverse cardiovascular events. We aimed to assess the dose-response relationship between Triglyceride-Glucose (TyG) Index and Major Adverse Cardiovascular Events (MACE) in patients with Acute Coronary Syndrome (ACS).
METHODS AND RESULTS
A systematic literature search was performed using PubMed, Scopus, and Embase for records published from the inception up until 7 February 2021. Studies that fulfilled all of these criteria were included: 1) prospective or retrospective observational studies reporting patients with ACS and 2) assessing the impact of TyG index on MACE with at least three quantitative classifications. The outcome of interest is MACE across the TyG index intervals. MACE was a composite of all-cause mortality, myocardial infarction, unstable angina pectoris, target vessel revascularization, cerebrovascular accidents, and heart failure. The effect estimates were reported as relative risks (RRs). There are 13,684 subjects from 4 studies included in this meta-analysis. This meta-analysis showed that the highest category of TyG index was associated with twofold MACE (RR 2.09 [1.59, 2.76], p < 0.001; I: 68.4%, p = 0.02) compared to the lowest category in patients with ACS. Dose-response meta-analysis showed that the relationship between TyG index and MACE was non-linear (p < 0.001), with statistical significance reached around TyG index 8.9 and increased non-linearly. The dose-response curve became significantly steeper after TyG index of 9.1-9.2.
CONCLUSION
TyG index was associated with MACE in patients with ACS in a non-linear fashion.
PROSPERO
CRD42021235765.
Topics: Acute Coronary Syndrome; Biomarkers; Blood Glucose; Diabetes Mellitus; Disease Progression; Humans; Insulin Resistance; Myocardial Revascularization; Predictive Value of Tests; Prognosis; Risk Assessment; Risk Factors; Triglycerides
PubMed: 34625361
DOI: 10.1016/j.numecd.2021.08.026 -
Complementary Therapies in Clinical... Nov 2021Despite that acupuncture is effective in treating anxiety, depression and chronic stable angina pectoris (CSAP), it remains unclear whether acupuncture can treat CSAP,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND OBJECTIVE
Despite that acupuncture is effective in treating anxiety, depression and chronic stable angina pectoris (CSAP), it remains unclear whether acupuncture can treat CSAP, anxiety and depression simultaneously. This systematic review and meta-analysis aimed to investigate the efficacy of acupuncture on CSAP-associated anxiety and depression.
METHODS
Eight electronic databases were searched to identify eligible randomized controlled trials (RCTs) or controlled clinical trials (i.e. "acupuncture alone or combined with standard care" versus " sham acupuncture alone, sham acupuncture with standard care, or standard care alone") from their inception to January 2021, which included PubMed, Embase, Web of Science, the Cochrane Library, CBM, CNKI, VIP and Wanfang Database. Data were extracted and meta analyses were performed using the RevMan 5.3. Risk of bias (ROB) 2.0 was used for methodological quality assessment. GRADEprofiler 3.2.2 was used to rate the quality of evidence.
RESULTS
Seven trials involving 893 subjects were included. Meta-analysis results showed that acupuncture combined with standard care was more effective in relieving anxiety and depression, reducing angina attack frequency, and angina pain intensity than sham acupuncture with standard care and standard care alone. In addition, the effect remained until 16 weeks after acupuncture. The safety of acupuncture for CSAP-associated anxiety and depression was also high. Nonetheless, the quality of evidence ranged from low to moderate.
CONCLUSION
Acupuncture may be used as an adjunctive therapy to treat CSAP-associated anxiety and depression. However, more high-quality RCTs are required to confirm our findings.
Topics: Acupuncture Therapy; Angina, Stable; Anxiety; Anxiety Disorders; Depression; Humans
PubMed: 34517216
DOI: 10.1016/j.ctcp.2021.101484 -
European Journal of Clinical... Jan 2022There is a lack of a comprehensive picture of plaque geometry and composition of unstable atherosclerotic lesions as observed with intravascular ultrasound techniques.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
There is a lack of a comprehensive picture of plaque geometry and composition of unstable atherosclerotic lesions as observed with intravascular ultrasound techniques. We analysed through a systematic review with meta-analysis 39 characteristics of atherosclerotic plaques in three scenarios involving culprit and non-culprit lesions from acute coronary syndromes vs stable angina pectoris patients, and culprit vs non-culprit lesions in acute coronary syndromes patients.
METHODS
A systematic search of PubMed and EMBASE, from inception to April 2020 was performed. The combined odds ratios or mean differences of all IVUS characteristics were calculated with random-effects models.
RESULTS
Twenty-eight studies involving 5434 subjects, and 5618 lesions were included. Culprit lesions in acute coronary syndromes have larger plaque areas and remodeling indexes (MD = 0.13 [0.08; 0.17], p < 0.001) and contained larger necrotic cores (MD = 0.67 (95% CI 0.19;1.15), p = 0.006) that stable angina culprit lesions. In acute patients, culprit plaques were also more remodeled, had larger necrotic cores and had more frequently a Thin-Cap Fibroatheroma morphology (OR = 1.79 (95% CI 1.21; 2.65), p = 0.004) than non-culprit lesions. Non-culprit lesions in acute syndromes were more often ruptured (OR = 2.25 (95% CI:1.05; 4.82), p = 0.037) or Thin-Cap Fibroatheromas than in stable angina.
CONCLUSION
Culprit lesions from acute coronary patients are larger, more positively remodeled and contained more lipids as compared to stable angina lesions or non-culprit in acute patients. Non culprit lesions are also more often complicated or vulnerable in acute than stable patients.
Topics: Coronary Artery Disease; Humans; Plaque, Atherosclerotic; Ultrasonography, Interventional
PubMed: 34411283
DOI: 10.1111/eci.13671 -
Open Heart Jul 2021Dual antiplatelet therapy (DAPT) has important implications for clinical outcomes in coronary disease. However, the optimal DAPT duration remains uncertain. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Dual antiplatelet therapy (DAPT) has important implications for clinical outcomes in coronary disease. However, the optimal DAPT duration remains uncertain.
METHODS AND RESULTS
We searched four major databases for randomised controlled trials comparing long-term (≥12 months) with short-term (≤6 months) or shorter (≤3 months) DAPT in patients with coronary syndromes. The primary outcome was all-cause mortality. Secondary outcomes were any bleeding and major bleeding (safety), cardiac death, myocardial infarction, stent thrombosis, revascularisation and stroke (efficacy). Nineteen randomised controlled trials (n=60 111) satisfied inclusion criteria, 8 assessed ≤3 months DAPT. Compared with long-term (≥12 months), short-term DAPT (≤6 months) was associated with a trend towards reduced all-cause mortality (RR: 0.90, 95% CI: 0.80 to 1.01) and significant bleeding reduction (RR: 0.68, 95% CI: 0.55 to 0.83 and RR: 0.66, 95% CI: 0.56 to 0.77 for major and any bleeding, respectively). There were no significant differences in efficacy outcomes. These associations persisted in sensitivity analysis comparing shorter duration DAPT (≤3 months) to long-term DAPT (≥12 months) for all-cause mortality (RR: 0.91, 95% CI: 0.79 to 1.05). In subgroup analysis, short-term DAPT was associated with lower risk of bleeding in patients with acute or chronic coronary syndromes (RR: 0.66, 95% CI: 0.54 to 0.81 and RR: 0.53, 95% CI: 0.33 to 0.65, respectively), but higher risk of stent thrombosis in acute coronary syndrome (RR: 1.49, 95% CI: 1.02 to 2.17 vs RR: 1.25, 95% CI 0.44 to 3.58).
CONCLUSION
Our meta-analysis suggests that short (≤6 months) and shorter (≤3 months) durations DAPT are associated with lower risk of bleeding, equivalent efficacy and a trend towards lower all-cause mortality irrespective of coronary artery disease stability.
Topics: Coronary Angiography; Coronary Artery Disease; Dual Anti-Platelet Therapy; Humans; Platelet Aggregation Inhibitors; Randomized Controlled Trials as Topic
PubMed: 34341097
DOI: 10.1136/openhrt-2021-001707 -
Evidence-based Complementary and... 2021Coronary heart disease (CHD) is a common clinical cardiovascular disease, and its morbidity and mortality rates are increasing, which brings a serious burden to the... (Review)
Review
INTRODUCTION
Coronary heart disease (CHD) is a common clinical cardiovascular disease, and its morbidity and mortality rates are increasing, which brings a serious burden to the family and society. Dyslipidemia is one of the most important risk factors for CHD. However, it is difficult to reduce blood lipids to an ideal state with the administration of a statin alone. Tongxinluo capsule (TXLC), as a Chinese patent medicine, has received extensive attention in the treatment of CHD in recent years. This systematic review and meta-analysis aim to provide evidence-based medicine for TXLC combined with atorvastatin in the treatment of CHD.
OBJECTIVE
To evaluate systematically the effectiveness and safety of TXLC combined with atorvastatin in the treatment of CHD.
METHODS
Seven English and Chinese electronic databases (PubMed, Cochrane Library, Embase, CNKI, VIP, CBM, and Wanfang) were searched from inception to January 2020, to search for randomized controlled trials (RCTs) on TXLC combined with atorvastatin in the treatment of CHD. Two researchers independently screened the literature according to the literature inclusion and exclusion criteria and performed quality assessment and data extraction on the included RCTs. We performed a systematic review following Cochrane Collaboration Handbook and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and using a measurement tool to assess the methodological quality of systematic reviews (AMSTAR 2). The quality of outcomes was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE). And meta-analysis was performed by Review Manager 5.2.
RESULTS
A total of 15 RCTs with 1,578 participants were included in this review. Compared to atorvastatin treatment, TXLC combined with atorvastatin treatment showed potent efficacy when it came to the effectiveness of clinical treatment (RR = 1.24; 95% CI, 1.18, 1.29; < 0.00001), total cholesterol (TC; MD = -1.21; 95% CI, -1.53, -0.89; < 0.00001), triacylglycerol (TG; MD = -0.73; 95% CI, -0.81, -0.65; < 0.00001), high-density lipoprotein cholesterol (HDL-C; MD = 0.27; 95% CI, 0.23, 0.31; < 0.00001), low-density lipoprotein cholesterol (LDL-C; MD = -0.72; 95% CI, -0.80, -0.64; < 0.00001), C-reactive protein (CRP; SMD = -2.06; 95% CI, -2.56, -1.57; < 0.00001), frequency of angina pectoris (SMD = -1.41; 95% CI, -1.97, -0.85; < 0.00001), duration of angina pectoris (MD = -2.30; 95% CI, -3.39, -1.21; < 0.0001), and adverse reactions (RR = 0.84; 95% CI, 0.51, 1.39; =0.50). No serious adverse events or reactions were mentioned in these RCTs. According to the PRISMA guidelines, although all studies were not fully reported in accordance with the checklist item, the reported items exceeded 80% of all items. With the AMSTAR 2 standard, the methodological quality assessment found that 9 studies were rated low quality and 6 studies were rated critically low quality. Based on the results of the systematic review, the GRADE system recommended ranking method was used to evaluate the quality of evidence and the recommendation level. The results showed that the level of evidence was low, and the recommendation intensity was a weak recommendation.
CONCLUSIONS
TXLC combined with atorvastatin in the treatment of CHD can effectively improve the effectiveness of clinical treatment, significantly reduce the frequency and duration of angina pectoris, decrease blood lipids, and improve inflammatory factors. However, due to the low quality of the literature included in these studies and the variability of the evaluation methods of each study, there is still a need for a more high-quality, large sample, multicenter clinical randomized control for further demonstration.
PubMed: 34335841
DOI: 10.1155/2021/9413704 -
International Journal of Cardiology Oct 2021Medical therapies are used to improve stable anginal symptoms and quality of life in clinical practice however the evidence for the use of antianginal medication in...
BACKGROUND
Medical therapies are used to improve stable anginal symptoms and quality of life in clinical practice however the evidence for the use of antianginal medication in women is largely unknown. We conducted a systematic review to investigate the extent of the evidence-base for the medical management of anginal symptoms in women with stable angina.
METHODS
MEDLINE, EMBASE, Cochrane and ClinicalTrials.gov databases were searched to the end of December 2019. Retrieved papers were hand searched. Included were randomised controlled trials with at least one week of follow-up that included women with stable angina pectoris, with or without significant coronary atherosclerosis, randomised to conventional antianginal medication or/and a comparator, with a primary or secondary endpoint of angina frequency or glyceryl trinitrate (GTN) consumption.
RESULTS
A total of 397 eligible publications were included in a qualitative analysis, with women comprising up to 20-30% of the study populations. No publication that included women and men reported all data separately for each sex. Twenty-six publications reported any female data separately from male data but only 18 reported angina data for women, 12 of which included fewer than 10 women.
CONCLUSIONS
Substantially fewer women than men were included in randomised trials of antianginal medications reporting effects on anginal symptoms, and reporting of data by sex was infrequent. As a result, there is little evidence on which to base treatment recommendations for anginal symptoms in women. Our results provide a platform for future studies to fill this void in the evidence.
Topics: Angina, Stable; Cardiovascular Agents; Female; Humans; Male; Quality of Life; Randomized Controlled Trials as Topic
PubMed: 34273431
DOI: 10.1016/j.ijcard.2021.07.018 -
Open Heart Jun 2021The COVID-19 pandemic has disrupted healthcare systems across the world. The rate of acute coronary syndrome (ACS) admissions during the pandemic has varied... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
The COVID-19 pandemic has disrupted healthcare systems across the world. The rate of acute coronary syndrome (ACS) admissions during the pandemic has varied significantly.
OBJECTIVES
The purpose of this study is to investigate the effect of the pandemic on ACS hospital admissions and to determine whether this is related to the number of COVID-19 cases in each country.
METHOD
Search engines including PubMed, Embase, Ovid and Google Scholar were searched from December 2019 to the 15 September 2020 to identify studies reporting ACS admission data during COVID-19 pandemic months in 2020 compared with 2019 admissions.
RESULTS
A total of 40 studies were included in this multistudy analysis. They demonstrated a 28.1% reduction in the rate of admission with ACS during the COVID-19 pandemic period compared with the same period in 2019 (total of 28 613 patients in 2020 vs 39 225 in 2019). There was a significant correlation between the absolute risk reduction in the total number of ACS cases and the number of COVID-19 cases per 100 000 population (Pearson correlation=0.361 (p=0.028)). However, the correlation was not significant for each of the ACS subgroups: non-ST-elevation myocardial infarction (STEMI) (p=0.508), STEMI (p=0883) and unstable angina (p=0.175).
CONCLUSION
There was a significant reduction in the rate of ACS admission during the COVID-19 pandemic period compared with the same period in 2019 with a significant correlation with COVID-19 prevalence.
Topics: Acute Coronary Syndrome; Angina, Unstable; COVID-19; Delivery of Health Care; Hospitalization; Humans; Non-ST Elevated Myocardial Infarction; Pandemics; SARS-CoV-2; ST Elevation Myocardial Infarction
PubMed: 34083389
DOI: 10.1136/openhrt-2021-001645