Xuesaitong injection treating acute myocardial infarction: A systematic review and meta-analysis

Background:Although the incidence of acute myocardial infarction (AMI) is decreasing, the mortality in AMI patients remains substantial. Traditional Chinese medicine has shown its role in the prevention and management of AMI. The purpose of this study is to evaluate the clinical efficacy of Xuesaitong injection (XST) for the treatment of AMI by a meta-analysis.Methods:A literature search was performed in 5 medical databases up to June 1, 2020. Randomized controlled trials involving XST combined with conventional treatment versus conventional treatment were included. A meta-analysis of clinical efficacy, left ventricular function and other objective parameters was performed to evaluate the effects of XST on AMI.Results:Five randomized controlled trials involving 539 participants were eventually included. Meta-analysis showed that the combination of XST and conventional treatment could achieve significantly better effect on improving clinical efficacy (risk ratio: 1.09 [1.01, 1.17]; P = .04), left ventricular ejection fraction (mean difference [MD]: 3.18 [1.69, 4.67]; P < .0001), hypersensitive C-reactive protein (MD: −2.58 [−5.04, −0.12]; P = .04), interleukin 6 (MD: −26.00 [−38.85, −13.16]; P < .0001), cardiac troponin T (MD: −15.85 [−18.09, −13.61]; P < .00001) and creatine kinase myocardial isoenzyme (MD: −73.06 [−79.74, −66.37]; P < .00001).Conclusion:XST combined with conventional treatment can achieve better efficacy on clinical performance and some of the AMI related parameters. However the interpretation of the results should be cautious, due to the relatively low quality of included trials. More rigorously designed, large-scaled, randomized controlled trials are warranted to support its clinical use in the future.     

Safety of coffee consumption after myocardial infarction: A systematic review and meta-analysis

Background and aimsThis systematic review aims to evaluate the impact of coffee consumption in patients with previous myocardial infarction (MI), in relation to all-cause and cardiovascular mortality, as well as other major cardiovascular events (MACE) such as stroke, heart failure, recurrent MI and sudden death.Methods and resultsMEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science Core Collection, SciELO Citation Database, Current Contents Connect®, KCI Korean Journal Database, African Index Medicus, and LILACS were searched for longitudinal studies evaluating the impact of coffee consumption in patients with previous myocardial infarction. We performed a random-effects meta-analysis to estimate the pooled hazard ratios (HR) with 95% confidence intervals (CI). The statistical heterogeneity was measured by I². A dose–response analysis was also conducted.Six prospective cohort studies were included in the primary meta-analysis. Consumption of coffee was associated with lower risk of cardiovascular mortality (HR = 0.70; 95% CI 0.54–0.91, I² = 0%; 2 studies) and was not associated with an increased risk of all-cause mortality (HR = 0.85; 95% CI 0.63–1.13; I² = 50%; 3 studies), recurrent MI (HR = 0.99; 95% CI 0.80–1.22; I² = 0%; 3 studies), stroke (HR = 0.97; 95% CI 0.63–1.49; I² = 39%; 2 studies) and MACE (HR = 0.96; 95% CI 0.86–1.07; I² = 0%; 2 studies). A significant non-linear inverse dose–response association was found for coffee consumption and all-cause mortality.ConclusionsConsumption of coffee was not associated with an increased risk of all-cause mortality and cardiovascular events in patients with previous myocardial infarction.     

Malignancy in patients with myocardial infarction and non-obstructive coronary arteries: A systematic review and meta-regression

BackgroundThe significance of malignancy in patients with myocardial infarction and non-obstructive coronary arteries (MINOCA) is poorly defined. This study aimed at determining the prevalence of malignancy and its association with long-term outcome in MINOCA.MethodsWe searched the MEDLINE, EMBASE, and CENTRAL databases up to March 31, 2020 to identify studies reporting data on malignancy in full. We performed a random effects meta-analysis of proportions and assessed statistical heterogeneity using the I2 statistic and meta-regression analysis.ResultsA total of 9 studies including 26,636 patients (11,910 men and 14,726 women) were selected for the meta-analysis. Of them, 655 patients (2.5%) had a diagnosis of malignancy at presentation. Comparison of presenting features and outcome between patients with MINOCA and patients with myocardial infarction and coronary artery disease (MI-CAD) showed that malignancy was significantly more common in the former as compared with the latter (p = 0.019). During a median follow-up of 39 months, 2,081 patients with MINOCA died (7.8%). Meta-regression analysis demonstrated that long-term mortality was associated with left ventricular ejection fraction (p = 0.0001; coefficient: -0.001; 95% CI: from -0.002 to 0.002), malignancy at presentation (p = 0.01; coefficient: 0.001; 95% CI: from -0.001 to 0.001), and use of beta-blockers during follow-up (p = 0.03; coefficient: 0.001; 95% CI: from -0.000 to 0.001).ConclusionThis study shows that the prevalence of malignancy in patients with MINOCA is not trivial and is significantly greater than in patients with MI-CAD. Malignancy is significantly associated with an unfavorable long-term prognosis in MINOCA.     

Revascularization strategies in cardiogenic shock complicating acute myocardial infarction: A systematic review and meta-analysis

BackgroundThe optimal revascularization strategy in patients with multi-vessel disease (MVD) presenting with acute myocardial infarction (AMI) and cardiogenic shock (CS) remains unclear.ObjectiveTo investigate the comparative differences between culprit-only revascularization (COR) versus instant multi-vessel revascularization (IMVR) in AMI and CS.Methods13 studies were selected using MEDLINE, EMBASE and the CENTRAL (Inception - 31 November2017). Outcomes were assessed at short-term (in-hospital or ≤30 days duration) and long-term duration (≥6 months). Estimates were reported as random effects relative risk (RR) with 95% confidence interval (CI).ResultsIn analysis of 7311 patients, COR significantly reduced the relative risk of short-term all-cause mortality (RR: 0.87; 95% CI, 0.77–0.97; p = 0.01, I² = 50%) and renal failure (RR: 0.75; 95% CI, 0.61–0.94; p = 0.01, I² = 7%) compared with IMVR. There were no significant differences between both the strategies in terms of reinfarction (RR: 1.25; 95% CI, 0.59–2.63; p = 0.56, I² = 0%), major bleeding (RR: 0.88; 95% CI, 0.75–1.04; p = 0.14, I² = 0%) and stroke (RR: 0.77; 95% CI, 0.50–1.17; p = 0.22, I² = 0%) at short term duration. Similarly, no significant differences were observed between both groups regarding all-cause mortality (RR; 1.01; 95% CI, 0.85–1.20; p = 0.93, I² = 61%) and reinfarction (RR: 0.71; 95% CI, 0.34–1.47; p = 0.35, I² = 26%) at long term duration.ConclusionIn MVD patients presenting with AMI and CS, IMVR was comparable to COR in terms of all-cause mortality at long term follow up duration. These results are predominantly derived from observational data and more randomized controlled trials are required to validate this impression.     

Comparison of carvedilol versus metoprolol in patients with acute myocardial infarction: A protocol for systematic review and meta-analysis

Background:The existing meta-analyses and randomized studies on comparing the effects of carvedilol and metoprolol are of poor quality, with small sample sizes, and involve a homogeneous population. Therefore, to provide new evidence-based medical evidence for clinical treatment, we undertook a systematic review and meta-analysis to compare the mortality benefits of carvedilol with metoprolol head to head and determine the better beta-blocker in acute myocardial infarction (AMI) setting.Methods:Seven electronic databases including Web of Science, Embase, PubMed, Wanfang Data, Scopus, Science Direct, Cochrane Library will be searched in May 2021 by 2 independent reviewers. The protocol was written following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement guidelines. The primary outcome is all-cause mortality; secondary outcomes include complex cardiovascular events, sudden death, cardiovascular death, reinfarction, revascularization, readmission, ventricular arrhythmias, and drug withdrawal for all causes except death. All outcomes are pooled on random-effect model. A P value of <.05 is considered to be statistically significant.Results:The review will add to the existing literature by showing compelling evidence and improved guidance in clinic settings.OSF registration number:10.17605/OSF.IO/VSTJC.     

Effect of exercise-based cardiac rehabilitation on anxiety and depression in patients with myocardial infarction: A systematic review and meta-analysis

Background

Cardiac rehabilitation (CR) has been shown to provide the best social, psychological and physical conditions for patient recovery after myocardial infarction (MI).

冠状动脉粥样硬化斑块与牙周致病菌的关系

目的 检测冠状动脉粥样硬化斑块中是否存在牙周致病菌,并比较同一患者动脉粥样硬化斑块及其龈下菌斑中的牙周致病菌的一致性,以探讨冠心病和牙周病之间可能的关系.方法 选择51例行冠状动脉搭桥术的患者,术前及术后分别收集龈下菌斑和冠状动脉粥样硬化斑块,采用牙周致病菌特异性引物,通过聚合酶链反应(PCR)技术,检测粥样硬化斑块及龈下菌斑中牙周致病菌的DNA并对扩增产物进行测序分析.结果 51例冠状动脉粥样硬化斑块中,牙龈卟啉单胞菌(P.g)的阳性率33%(17例),福赛类杆菌(T.f)的阳性率31%(16例),中问普氏菌(P.i)的阳性率18%(9例),具核梭杆菌(F.n)的阳性率12%(6例),未检测出伴放线放线杆菌(A.a).51例龈下菌斑中,T.f阳性率84%(43例),F.n阳性率78%(40例),P.i阳性率59%(30例),P.g阳性率39%(20例),A.a阳性率22%(11例);32例患者同时在动脉粥样硬化斑块及龈下菌斑中检测出牙周致病菌.结论 冠状动脉粥样硬化斑块中存在牙周致病菌,牙周致病菌在冠状动脉粥样硬化发生、发展过程中起一定的作用,可能和冠心病发病相关.     

Drug-coated balloon versus drug-eluting stent in acute myocardial infarction: A protocol for systematic review and meta-analysis

Background:Previous studies comparing the published literature on drug-eluting stents (DES) and drug-coated balloon (DCB) have drawn divergent conclusions, as these studies are limited by small sample sizes. To overcome these limitations, we thus conducted a high-quality systematic review and meta-analysis to assess the efficacy and safety of DCB versus DES for patients with acute myocardial infarction (AMI). It was hypothesized that DCB use at the AMI is associated with decreased risk of cardiovascular disease and death.Methods:The electronic databases Embase, Medline, PubMed, and Cinahl were searched from the earliest available date until August 2021. Study included in our study had to meet all of the following inclusion criteria: all randomized controlled trials to assess the efficacy and safety of DES versus DCB in the treatment of AMI were considered eligible for analysis; participants received DCB or DES; reporting the available data on cardiac death, all-cause death, myocardial infarction, target lesion revascularization, target vessel revascularization, major adverse cardiac events, and stent thrombosis. Review Manager Software (v 5.3; Cochrane Collaboration) was used for the meta-analysis. Two of us independently assessed the risk of bias in the included studies using parameters defined in the Cochrane Handbook for Systematic Reviews of Interventions criteria.Results:It was hypothesized that DCB use at the AMI is associated with decreased risk of cardiovascular disease and death.Registration number:10.17605/OSF.IO/AVTYW.     

Sex differences in symptom presentation in acute myocardial infarction: a systematic review and meta-analysis

Background

Recognition of sex differences in symptom presentation of acute myocardial infarction (AMI) is important for timely clinical diagnosis. This review examined whether women are equally as likely as men to present with chest pain.

Methods

We conducted a systematic review and meta-analysis of English language research articles published between 1990 and 2009.

Results

Meta-analysis showed women with AMI had lower odds and a lower rate of presenting with chest pain than men (odds ratio .63; 95% confidence interval, .59-.68; risk ratio .93; 95% confidence interval, .91-.95). Women were significantly more likely than men to present with fatigue, neck pain, syncope, nausea, right arm pain, dizziness, and jaw pain.

Conclusion

Health campaigns on symptom presentation of AMI should continue to promote chest pain as the cardinal symptom of AMI, but also reflect a wider spectrum of possible symptoms and highlight potential differences in symptom presentation between men and women.     

Hypothermia therapy for the treatment of acute myocardial infarction: A protocol for systematic review and meta-analysis

Background:In patients with acute myocardial infarction (AMI) receiving percutaneous coronary intervention (PCI), the role of systemic therapeutic hypothermia remains controversial. We performed a protocol for systematic review and meta-analysis to investigate the effect of systemic therapeutic hypothermia in patients with AMI receiving PCI.Methods:This study will use the Cochrane Library, Web of Science, PubMed, Embase, Allied and Complementary Medicine Database, China Biomedical Literature Database, China National Knowledge Infrastructure, China Science and Technology Journal Database, Wanfang Database, and Ongoing Clinical Trials Database. The search terms were hypothermia, cooling, myocardial infarction, myocardial ischemia and acute coronary syndrome. Quality assessment of the included studies was evaluated using the Cochrane risk of bias assessment tool. Statistical analyses were performed using RevMan 5.4 software.Results:The findings of this study will be submitted to peer-reviewed journals for publication.Conclusion:This systematic review will provide evidence to determine whether hypothermia therapy is an effective and safe intervention for patients with AMI receiving PCI.Registration number: 10.17605/OSF.IO/9XJSB.     

Leptin and coronary heart disease: A systematic review and meta-analysis

Introduction

Leptin, an adipose tissue-derived hormone, plays a central role in regulating human energy homeostasis. The role of leptin in regulating blood pressure, activating the sympathetic nervous system, insulin resistance, platelet aggregation, arterial thrombosis, angiogenesis, and inflammatory vascular responses suggests that leptin may have a close relationship with the development of coronary heart disease (CHD). However, no conclusive data are available to determine the association between leptin and CHD.

Methods

The PubMed, EMBASE and Cochrane databases were surveyed for original studies describing the association between leptin and CHD outcome from the date of publication of each database through March 2013. The data were extracted by two investigators independently.

Results

The meta-analysis reported here was comprised of eight original articles with a total of 21,064 participants (10,842 men, 10,222 women) and 2053 CHD events. The odds ratio for the sociodemographic-adjusted study reported here was 1.57 (95% confidence interval, 1.14–2.16) and 1.72 (95% confidence internal, 1.03–2.87) in males and females, respectively. Further adjustment for additional cardiovascular risk factors resulted in an odds ratio of 1.36 (95% confidence interval, 0.98–1.88) in males and 1.50 (95% confidence interval, 0.93–2.42) in females. Sensitivity analysis restricted to sociodemographics-adjusted studies with high methodological quality indicated an estimate of 1.47 (95% confidence internal, 1.06–2.04) in males and 1.85 (95% confidence internal, 0.61–5.63) in females. Sensitivity analysis restricted to cardiovascular risk factor-adjusted studies showed no significant differences in both males and females.

Conclusion

The results of the meta-analysis represents the most precise and accurate estimate of the relationship between leptin and CHD. Although the associations of leptin and CHD were not statistically significant both in male and female overall, males with high levels of leptin should be paid more attention to. Our findings highlight the need for additional well-designed and gender-specific prospective studies to evaluate the role of leptin on the development of CHD.     

Impact of administration of nicorandil prior to percutaneous coronary intervention in treatment of acute myocardial infarction: A protocol for systematic review and meta-analysis

Background:In order to provide new evidence-based medical evidence for clinical treatment, we undertook a systematic review and meta-analysis to assess the efficacy and safety of nicorandil prior to percutaneous coronary intervention in acute myocardial infarction (AMI) patients.Methods:This systematic review and meta-analysis will be performed according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Two reviewers independently will search randomized controlled trials or observational studies about the treatment of nicorandil on AMI patients. Retrieved databases include Web of Science, ClinicalTrials.gov, Pubmed, Embase, and Cochrane Library. And retrieval time is limited from inception to June 2021. Key words are nicorandil, myocardial infarction, or similar expansion words without publication limitation. Biomechanical studies, in vitro studies, review articles, techniques, case reports, letters to the editor, and editorials are excluded.Results:The results of our review will be reported strictly following the PRISMA criteria and the review will add to the existing literature by showing compelling evidence and improved guidance in clinic settings.OSF registration number:10.17605/OSF.IO/UEPKB.