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Abdelaziz A, Elsayed H, Atta K, Mechi A, Kadhim H, Aboutaleb AM, Elaraby A, Ellabban MH, Eid M, AboElfarh HE, Ibrahim RA, Zawaneh EA, Ezzat M, Abdelaziz M, Hafez A, Mahmoud A, Ghaith HS, Suppah M. A comprehensive guide on the optimal timing of PCI in the setting of acute coronary syndrome: An updated meta-analysis. Int J Cardiol 2024; 400:131774. [PMID: 38211674 DOI: 10.1016/j.ijcard.2024.131774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/19/2023] [Accepted: 01/07/2024] [Indexed: 01/13/2024]
Abstract
BACKGROUND Invasive revascularization is recommended for cohorts of patients with ST-elevation myocardial infarction (STEMI) and non-ST-elevation acute coronary syndrome (NSTE-ACS). However, the optimal timing of invasive revascularization is still controversial and no defined consensus is established. We aim to give a comprehensive appraisal on the optimal timing of invasive strategy in the heterogenous population of ACS. METHODS Relevant studies were assessed through PubMed, Scopus, Web of science, and Cochrane Library from inception until April 2023. Major adverse cardiovascular events (MACE) and all-cause mortality were our primary outcomes of interest, other secondary outcomes were cardiac death, TVR, MI, repeat revascularization, recurrent ischemia, and major bleeding. The data was pooled as odds ratio (OR) with its 95% confidence interval (CI) in a random effect model using STATA 17 MP. RESULTS A total of 26 studies comprising 21,443 patients were included in the analysis. Early intervention was favor to decrease all-cause mortality (OR = 0.79, 95% CI: 0.64 to 0.98, p = 0.03), when compared to delayed intervention. Subgroup analysis showed that early intervention was significantly associated with all-cause mortality reduction in only NSTE-ACS (OR = 0.83, 95% CI [0.7 to 0.99], p = 0.04). However, there was no significant difference between early and delayed intervention in terms of MACE, cardiac death, TVR, MI, repeat revascularization, recurrent ischemia, and major bleeding. CONCLUSION An early intervention was associated with lower mortality rates compared to delayed intervention in NSTE-ACS with no significant difference in other clinical outcomes. PROSPERO registration: CRD42023415574.
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Affiliation(s)
- Ahmed Abdelaziz
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
| | - Hanaa Elsayed
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Karim Atta
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Institute of Medicine, National Research Mordovia State University, Saransk, Russia
| | - Ahmed Mechi
- University of Kufa, Medicine College, Internal Medicine Department, Najaf, Iraq
| | | | - Aya Moustafa Aboutaleb
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Elaraby
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed Hatem Ellabban
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mahmoud Eid
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Hadeer Elsaeed AboElfarh
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Mansoura Manchester Programme for Medical Education, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Rahma AbdElfattah Ibrahim
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Kafr Elsheikh University, Kafr Elsheikh, Egypt
| | - Emad Addin Zawaneh
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of medicine, Jordan university of science and technology, Irbid, Jordan
| | - Mahmoud Ezzat
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Mohamed Abdelaziz
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Abdelrahman Hafez
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Mahmoud
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Hazem S Ghaith
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mustafa Suppah
- Department of Cardiovascular Medicine, Mayo Clinic, 13400 E Shea Boulevard, Scottsdale, AZ 85259, USA
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Abdelwahab OA, Mechi A, Gahlan S, Hamadein FE, Kadhim H, Ismail D, Soliman Y, El-Samahy M. Efficacy and safety of mycophenolate mofetil in patients with immune thrombocytopenic purpura: a systematic review and meta-analysis. Clin Rheumatol 2024; 43:621-632. [PMID: 37981614 PMCID: PMC10834632 DOI: 10.1007/s10067-023-06820-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/09/2023] [Accepted: 11/14/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Immune thrombocytopenic purpura (ITP) is a challenging disease in its presentation and management as it may cause life-threatening hemorrhaging in vital organs and may resist several lines of treatment. This systematic review and meta-analysis aimed to evaluate the safety and efficacy of mycophenolate mofetil (MMF) in treating patients with ITP. METHODS We systematically searched four electronic databases (PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials) from inception until 10 October 2022. We included all clinical trials, either controlled or single arm, and prospective and retrospective observational studies that evaluate the efficacy and safety of MMF in patients with ITP. We assessed the risk of bias using three tools (ROBINS-I, Cochrane ROB-2, and NIH), each for eligible study design. RESULTS Nine studies were included in this meta-analysis, with a total of 411 patients with ITP. We found that MMF demonstrated an overall response rate of (62.09%; 95% CI = [43.29 to 77.84]) and the complete response rate was (46.75%; 95% CI = [24.84 to 69.99]). The overall proportion of adverse events was (12%; 95% CI = [6 to 24]). After the sensitivity analysis, the overall response rate became 50%; 95% CI = [38 to 63]) and the complete response rate became (32%; 95% CI = [24 to 42]). However, MMF did not appear to affect white blood cell counts or hemoglobin levels significantly. CONCLUSION This systematic review and meta-analysis demonstrate that MMF appears to be an effective and relatively safe treatment option for patients with ITP when combined with steroids and even in those who have not responded to standard therapies (steroid-resistant cases). Further research with well-designed studies is warranted to better understand the factors influencing treatment response and to refine the use of MMF in the management of ITP. An interactive version of our analysis can be accessed from here: https://databoard.shinyapps.io/mycophenolate_meta/.
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Affiliation(s)
- Omar Ahmed Abdelwahab
- Faculty of Medicine, Al-Azhar University, Cairo, 11884, Egypt.
- Medical Research Group of Egypt, Cairo, Egypt.
| | - Ahmed Mechi
- Medical Research Group of Egypt, Cairo, Egypt
- Internal Medicine Department, Medicine College, University of Kufa, Najaf, Iraq
| | - Shereen Gahlan
- Faculty of Medicine, Al-Azhar University, Cairo, 11884, Egypt
- Medical Research Group of Egypt, Cairo, Egypt
| | | | - Hallas Kadhim
- Medical Research Group of Egypt, Cairo, Egypt
- College of Medicine, Al-Muthanna University, Samawah, Iraq
| | - Doaa Ismail
- Medical Research Group of Egypt, Cairo, Egypt
- Faculty of Medicine, Zagazig University, Zagazig, El-Sharkia, Egypt
| | - Youssef Soliman
- Medical Research Group of Egypt, Cairo, Egypt
- Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed El-Samahy
- Medical Research Group of Egypt, Cairo, Egypt
- Faculty of Medicine, Zagazig University, Zagazig, El-Sharkia, Egypt
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Abdelaziz A, Hafez A, Atta K, Elsayed H, Abdelaziz M, Elaraby A, Kadhim H, Mechi A, Ezzat M, Fadel A, Nasr A, Bakr A, Ghaith HS. Correction: Drug-coated balloons versus drug-eluting stents in patients with acute myocardial infarction undergoing percutaneous coronary intervention: an updated meta-analysis with trial sequential analysis. BMC Cardiovasc Disord 2024; 24:36. [PMID: 38191295 PMCID: PMC10775574 DOI: 10.1186/s12872-023-03688-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2023] [Indexed: 01/10/2024] Open
Affiliation(s)
- Ahmed Abdelaziz
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Abdelrahman Hafez
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Karim Atta
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Institute of Medicine, National Research Mordovia State University, Saransk, Russia
| | - Hanaa Elsayed
- Medical Research Group of Egypt (MRGE), Cairo, Egypt.
- Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Mohamed Abdelaziz
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Elaraby
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Hallas Kadhim
- Al Muthanna University College of Medicine, Samawah, Iraq
| | - Ahmed Mechi
- Medicine College, Internal Medicine Department, University of Kufa, Najaf, Iraq
| | - Mahmoud Ezzat
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Ahmed Fadel
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Ahmed Nasr
- Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Ali Bakr
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Hazem S Ghaith
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Abdelaziz A, Elsayed H, Hamdaalah A, Atta K, Mechi A, Kadhim H, Aboutaleb AM, Elaraby A, Ellabban MH, Rzk FM, Eid M, AboElfarh HE, Ibrahim RA, Zawaneh EA, Ezzat M, Abdelaziz M, Hafez AH, Fadel S, Ghaith HS, Suppah M. Safety and feasibility of rotational atherectomy (RA) versus conventional stenting in patients with chronic total occlusion (CTO) lesions: a systematic review and meta-analysis. BMC Cardiovasc Disord 2024; 24:4. [PMID: 38166554 PMCID: PMC10763069 DOI: 10.1186/s12872-023-03673-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/13/2023] [Indexed: 01/04/2024] Open
Abstract
BACKGROUND AND AIM Interventional cardiologists face challenges in managing chronic total occlusion (CTO) lesions, with conflicting results when comparing rotational atherectomy (RA) to conventional PCI. This meta-analysis aims to provide a critical evaluation of the safety and feasibility of RA in CTO lesions. METHODS PubMed, Scopus, Web of Science, Ovid, and Cochrane central library until April 2023 were searched for relevant studies. MACE was our primary outcomes, other outcomes were all cause of death, cardiac death, MI, and TVR. Also, we reported angiographic outcomes as technical success, procedural success, and procedural complications in a random effect model. The pooled data was analyzed using odds ratio (OR) with its 95% CI using STATA 17 MP. RESULTS Seven studies comprising 5494 patients with a mean follow-up of 43.1 months were included in this meta-analysis. Our pooled analysis showed that RA was comparable to PCI to decrease the incidence of MACE (OR = 0.98, 95% CI [0.74 to 1.3], p = 0.9). Moreover, there was no significant difference between RA and conventional PCI in terms of other clinical or angiographic outcomes. CONCLUSION Our study showed that RA had comparable clinical and angiographic outcomes as conventional PCI in CTO lesions, which offer interventional cardiologists an expanded perspective when addressing calcified lesions. PROSPERO REGISTRATION CRD42023417362.
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Affiliation(s)
- Ahmed Abdelaziz
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Hanaa Elsayed
- Medical Research group of Egypt (MRGE), Cairo, Egypt.
- Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | | | - Karim Atta
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Institute of Medicine, National Research Mordovia State University, Saransk, Russia
| | - Ahmed Mechi
- Internal Medicine Department, Medicine College, University of Kufa, Najaf, Iraq
| | - Hallas Kadhim
- College of Medicine, Al Muthanna university, Samawah, Iraq
| | - Aya Moustafa Aboutaleb
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Elaraby
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohamed Hatem Ellabban
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Fayed Mohamed Rzk
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Mahmoud Eid
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Hadeer Elsaeed AboElfarh
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Neurology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Rahma AbdElfattah Ibrahim
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Kafr Elsheikh University, Kafr Elsheikh, Egypt
| | - Emad Addin Zawaneh
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Faculty of medicine, Jordan university of science and technology, Irbid, Jordan
| | - Mahmoud Ezzat
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Mohamed Abdelaziz
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Abdelrahman H Hafez
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Shaimaa Fadel
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Hazem S Ghaith
- Medical Research group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mustafa Suppah
- Department of Cardiovascular Medicine, Mayo Clinic, 13400 E Shea Boulevard, Scottsdale, AZ, 85259, USA
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Abdelaziz A, Hafez A, Atta K, Elsayed H, Abdelaziz M, Elaraby A, Kadhim H, Mechi A, Ezzat M, Fadel A, Nasr A, Bakr A, Ghaith HS. Drug-coated balloons versus drug-eluting stents in patients with acute myocardial infarction undergoing percutaneous coronary intervention: an updated meta-analysis with trial sequential analysis. BMC Cardiovasc Disord 2023; 23:605. [PMID: 38066453 PMCID: PMC10709955 DOI: 10.1186/s12872-023-03633-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/25/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Drug-coated balloons (DCBs) are an established strategy for coronary artery disease. However, the new generation drug-eluting stent (DES) is recommended for patients with Acute myocardial infarction (AMI) for coronary artery revascularization. Our aim is to provide a comprehensive appraisal of the efficacy of DCBs in patients with AMI undergoing PCI. METHODS We searched the WOS, PubMed, Scopus, and Cochrane CENTRAL till March 2023, for studies that compared DCBs versus DES in patients with AMI undergoing PCI. We used a random-effects model to compare major adverse cardiac events (MACE), cardiac death, all-cause death, myocardial infarction, target lesion revascularization (TLR), stent thrombosis, Late lumen Loss (LLL), and minimum lumen diameter (MLD) between the two groups. RESULTS Thirteen studies comprising 2644 patients were included. The pooled OR showed non-inferiority of DCB over DES in terms of MACE (OR = 0.89, 95% CI [0.57 to 1.40], p = 0.63). When we defined MACE as a composite of cardiac death, MI, and TLR; the pooled OR favored DCB over DES (OR = 0.50, 95% CI [0.28 to 0.9], p = 0.02). Moreover, DCB was not inferior to DES in terms of all-cause mortality (OR = 0.88, 95% CI: 0.43 to 1.8, p = 0.73), cardiac mortality, (OR = 0.59, 95% CI: 0.22 to 1.56, p = 0.29), MI (OR = 0.88, 95% CI: 0.34 to 2.29, p = 0.79), stent thrombosis (OR = 1.21, 95% CI: 0.35 to 4.23, p = 0.76), TLR (OR = 0.9, 95% CI: 0.43 to 1.93, p = 0.8), LLL (MD = -0.6, 95% CI: -0.3 to 0.19, p = 0.64), or MLD (MD = -0.4, 95% CI: -0.33 to 0.25, p = 0.76). CONCLUSION Our meta-analysis indicated that DCB intervention was not inferior to DES in the PCI setting in patients with AMI, and can be recommended as a feasible strategy in AMI. PROSPERO REGISTRATION CRD42023412757.
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Affiliation(s)
- Ahmed Abdelaziz
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Abdelrahman Hafez
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Institute of Medicine, National Research Mordovia State University, Saransk, Russia
| | - Karim Atta
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Institute of Medicine, National Research Mordovia State University, Saransk, Russia
| | - Hanaa Elsayed
- Medical Research Group of Egypt (MRGE), Cairo, Egypt.
- Faculty of Medicine, Zagazig University, Zagazig, Egypt.
| | - Mohamed Abdelaziz
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Elaraby
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Hallas Kadhim
- Al Muthanna University College of Medicine, Samawah, Iraq
| | - Ahmed Mechi
- Medicine College, Internal Medicine Department, University of Kufa, Najaf, Iraq
| | - Mahmoud Ezzat
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Ahmed Fadel
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Ahmed Nasr
- Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Ali Bakr
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Hazem S Ghaith
- Medical Research Group of Egypt (MRGE), Cairo, Egypt
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Abuelazm M, Ali S, Mahmoud A, Mechi A, Kadhim H, Katamesh BE, Elzeftawy MA, Ibrahim AA, Abdelazeem B. High versus low mean arterial pressure targets after out-of-hospital cardiac arrest: A systematic review and meta-analysis of randomized controlled trials. J Crit Care 2023; 78:154365. [PMID: 37516092 DOI: 10.1016/j.jcrc.2023.154365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/02/2023] [Accepted: 07/03/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Targeting a specific mean arterial pressure (MAP) has been evaluated as a treatment strategy after out-of-hospital cardiac arrest (OHCA) resuscitation. However, the current evidence lacks clear guidelines regarding the optimal MAP target after OHCA. METHODS A systematic review and meta-analysis synthesizing randomized controlled trials (RCTs), retrieved by systematically searching: PubMed, EMBASE, WOS, SCOPUS, and Cochrane through January 18th, 2023. Our review protocol was prospectively published on PROSPERO with ID: CRD42023395333. RESULTS Four RCTs with a total of 1065 patients were included in our analysis. There was no difference between high MAP versus low MAP regarding the primary outcomes: all-cause mortality (RR: 1.07 with a 95% CI [0.91, 1.27], P = 0.4) and favorable neurological recovery (RR: 1.02 with a 95% CI [0.93, 1.13], P = 0.68). However, high MAP target was significantly associated with decreased ICU stay duration (MD: -0.78 with a 95 CI [-1.54, -0.02], P = 0.04) and mechanical ventilation duration (MD: -0.91 with a 95 CI of [-1.51, -0.31], P = 0.003). CONCLUSION A high MAP target may reduce ICU stay and mechanical ventilation duration but did not demonstrate improvements in either mortality or favorable neurological recovery. Therefore, the role of high MAP target remains uncertain and requires further RCTs.
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Affiliation(s)
| | - Shafaqat Ali
- Department of Internal Medicine, Louisiana State University, Shreveport, LA, USA
| | | | - Ahmed Mechi
- Department of Internal Medicine, Medicine College, University of Kufa, Najaf, Iraq
| | - Hallas Kadhim
- Department of Internal Medicine, University of Al Muthanna, Al Muthanna, Iraq
| | - Basant E Katamesh
- Faculty of Medicine, Tanta University, Tanta, Egypt; General internal medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | - Basel Abdelazeem
- Department of Cardiology, West Virginia University, Morgantown, WV, USA
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Abdelaziz A, Elsayed H, Atta K, Mechi A, Kadhim H, Aboutaleb AM, Elaraby A, Hafez A, Bakr A, Mohamed Rzk F, Elshahat A, Bakr M, Zawaneh EA, Ezzat M, Abdelaziz M, Fadel S, Ghaith HS, Singer E, Suppah M. Short- and Long-term Outcomes of Percutaneous Coronary Interventions in Chronic and Non-chronic Total Occlusions: A Meta-analysis of 690,123 Patients. Curr Probl Cardiol 2023; 48:101890. [PMID: 37336307 DOI: 10.1016/j.cpcardiol.2023.101890] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
The use of percutaneous coronary intervention (PCI) in patients with chronic total occlusion (CTO) is still a subject of debate, with conflicting outcomes reported in different studies when compared to non-CTO lesions. This meta-analysis aims to clarify the clinical outcomes of PCI in CTO cases compared to non-CTO lesions, both in the short and long-term. PubMed, Scopus, Web of Science, Ovid, and Cochrane Central were searched until March 2023 for relevant studies addressing short- and long-term outcomes of PCI in CTO vs non-CTO lesions. Dichotomous data were pooled as odds ratio (OR) with its 95% confidence interval (CI) in a random Der-Simonian lair effect model using STATA 17 MP. Eight studies with a total of 690,123 patients were included. In terms of short-term outcomes, CTO PCI was associated with higher rates of vessel perforation (OR = 2.16, 95% CI: 1.31-3.57) and cardiac tamponade (OR = 5.19, 95% CI: 4.29-6.28). Additionally, CTO PCI showed lower rates of procedural success (OR = 0.84, 95% CI: 0.73-0.96). Moreover, in the long-term, CTO PCI had higher rates of MACE (OR = 1.02, 95% CI: 1.01-1.04), however, it showed lower rates of cardiac death (OR = 0.61, 95% CI: 0.38-0.98), with no significant difference in other reported outcomes. Our findings underscore the challenges and adverse outcomes associated with using PCI to treat CTO lesions in the short term. This suggests that interventional cardiologists should carefully evaluate the risks and benefits before proceeding with PCI in CTO lesions.
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Affiliation(s)
- Ahmed Abdelaziz
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt.
| | - Hanaa Elsayed
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Karim Atta
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Institute of Medicine, National Research Mordovia State University, Saransk, Russia
| | - Ahmed Mechi
- Department of Internal Medicine, University of Kufa, Medicine College, Najaf, Iraq
| | | | - Aya Moustafa Aboutaleb
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed Elaraby
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Abdelrahman Hafez
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ali Bakr
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Fayed Mohamed Rzk
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Ahmed Elshahat
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mohammed Bakr
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Emad Addin Zawaneh
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of medicine, Jordan university of science and technology, Irbid, Jordan
| | - Mahmoud Ezzat
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Mohamed Abdelaziz
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Shaimaa Fadel
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Hazem S Ghaith
- Medical Research group of Egypt (MRGE), Cairo, Egypt; Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Emad Singer
- University of Texas MD Anderson, Houston, TX
| | - Mustafa Suppah
- Department of Cardiovascular Medicine, Mayo Clinic, Scottsdale, AZ
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Nafakhi A, Rabeea IS, Al‐Darraji R, Nafakhi H, Mechi A, Al‐Khalidi A, alareedh M. Association of ABO blood group with in-hospital adverse outcome and long term persistent symptoms of COVID-19 infection: A single-center longitudinal observational study. Health Sci Rep 2022; 5:e656. [PMID: 35620543 PMCID: PMC9125875 DOI: 10.1002/hsr2.656] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 11/11/2022] Open
Abstract
Background and Aims There are gaps in knowledge regarding the association between the ABO blood group and coronavirus disease 2019 (COVID-19) immediate and long-term outcomes. We aimed to investigate the association of ABO blood group with COVID-19 in-hospital adverse outcomes and to determine whether ABO blood group is associated with post-COVID-19 persistent symptoms. Methods This was a single-center longitudinal observational study that included patients who presented with symptoms suggestive of COVID-19 infection and a positive test for COVID-19 and were able to attend the out-patient clinic after 6 months following acute COVID-19. The main outcomes were intensive care unit admission, the requirement for respiratory support, in-hospital death, and persistent symptoms. χ 2 test and regression analysis were used to analyze the collected data. Results A total of 169 patients were enrolled for the assessment of in-hospital adverse outcomes of whom 86 patients were included for the assessment of persistent symptoms after the exclusion of deceased patients or patients not attended the out-patient clinic. Patients with blood group B had higher prevalence of in-hospital death compared to blood group O (39% vs. 13%, p = 0.01) and this persisted after adjusting for sex (odds ratio, OR [confidence interval, CI] = 1.4 [1.1-2.1], p = 0.04), while patients with blood group AB had higher prevalence of requiring respiratory support than blood group O (54% vs. 10%, p = 0.02) and this persisted after adjusting for age (OR [CI] = 1.5 [1.1-2.3], p = 0.02). Concerning the association of ABO blood group and long-term symptoms, blood group AB showed a higher prevalence of palpitation (p < 0.001) and dizziness (p = 0.02) than other blood groups. Conclusions Blood groups AB and B are significantly associated with respiratory support use and in-hospital death, respectively, compared to blood group O. Blood group AB is significantly associated with persistent palpitation and dizziness compared to other blood groups.
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Affiliation(s)
- Ahmed Nafakhi
- Researcher Research UnitNajaf Health Bureau, Ministry of HealthNajafIraq
| | - Ihsan S. Rabeea
- Department of Clinical PharmacyFaculty of Pharmacy, University of KufaNajafIraq
| | - Rasha Al‐Darraji
- Allergy and Asthma Center, Specialized Centers DepartmentAl‐Sader Teaching Hospital, Najaf Health Bureau, Ministry of HealthNajafIraq
| | - Hussein Nafakhi
- Internal Medicine DepartmentMedicine College, University of KufaNajafIraq
| | - Ahmed Mechi
- Internal Medicine DepartmentMedicine College, University of KufaNajafIraq
| | - Alhan Al‐Khalidi
- Internal Medicine DepartmentMedicine College, Jabir Ibn Hayan Medical UniversityNajafIraq
| | - Mohammed alareedh
- Internal Medicine DepartmentMedicine College, University of KufaNajafIraq
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Nafakhi A, Rabeea I, AL-Darraji R, Nafakhi H, Mechi A, Al-khalidi A. COVID-19 clinical outcomes in patients with and without ongoing therapy with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. Arterial Hypertension 2022. [DOI: 10.5603/ah.a2022.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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