British Heart Journal最新文献

{"title":"The synergy of myopathic valvular disease","authors":"R. Alharethi, R. A. Butschek, Kismet Rasmusson, B. Whisenant","doi":"10.1136/heartjnl-2022-321214","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-321214","url":null,"abstract":"With recent advancements in the treatment of heart failure with reduced ejection fraction (HFrEF) including the addition of angiotensin receptor–neprilysin inhibitor, sodium–glucose cotransporter 2 inhibitors (SGLT2i) and transcatheter edgetoedge mitral valve repair (TEER), the treatment of patients with cardiomyopathy and secondary mitral regurgitation (SMR) has become increasingly complex and can lead to suboptimal utilisation of indicated therapies. Tanaka and colleagues have provided a realworld analysis of guidelinedirected medical therapy (GDMT) among HFREF patients with SMR and managed with TEER. Their findings reinforce the importance of engaging focused heart failure (HF) cardiologists and allied teams to optimise medical therapy before and after TEER. Consistent with the 2021 European Society of Cardiology guideline on HF management, the authors define GDMT as modulation of the renin–angiotensin–aldosterone and sympathetic nervous systems with triple therapy including renin–angiotensin system (RAS) inhibitors, betablockers (BBs) and mineralocorticoid receptor antagonists (MRAs) noting that SGLT2is were approved after study completion. Their results demonstrated the clinical benefits of maintaining triple therapy neuromodulation following TEER. They have thus provided a pragmatic and simple threshold of GDMT that will undoubtedly improve the care of patients with SMR undergoing TEER. Tanaka et al retrospectively divided patients with SMR and left ventricular ejection fraction (LVEF) <50% who underwent TEER into GDMT and nonGDMT cohorts. Local heart teams optimised medical therapy and decided when to perform TEER. As such, this is a realworld population of patients with SMR managed with TEER. GDMT was defined as patients who received triple therapy at the time of discharge with RAS inhibitors, BBs and MRAs of any doses. Nevertheless, among the GDMT cohort, only 21% of patients received target doses of BBs, and only 12% received target doses of RAS inhibitors. NonGDMT patients were prescribed optimal medical therapy per the local heart team consensus including BBs in 84% (16% with target doses), and RAS inhibitors in 60% (12% at target doses). While all GDMT patients were prescribed MRAs, only 22% of nonGDMT patients were prescribed MRAs. Among patients without GDMT, 42% had factors related to ineligibility (ie, systolic blood pressure <100 mm Hg, heart rate <60 bpm or estimated glomerular filtration rate <30 mL/min/m). This underscores the difference between relative ineligibility to a medication and the intolerance to this medication with the inherent complexity of providing detailed reasons for intolerance of GDMT, which were not recorded in this study. We are not sure if the lack of triple therapy in the nonGDMT cohort and the less than target doses of medications in both cohorts represents the absolute maximally tolerated medical therapy. Twoyear mortality was compared between groups after calculating propensity scores and performing ","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1670 - 1671"},"PeriodicalIF":0.0,"publicationDate":"2022-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44168303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An interesting case of fever and left ventricular systolic dysfunction","authors":"A. Ioannou","doi":"10.1136/heartjnl-2022-320831","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-320831","url":null,"abstract":"20 Webb JG, Pate GE, Munt BI. Percutaneous closure of an aortic prosthetic paravalvular leak with an Amplatzer duct occluder. Catheter Cardiovasc Interv 2005;65:69–72. 21 Piéchaud JF. Percutaneous closure of mitral paravalvular leak. J Interv Cardiol 2003;16:153–5. 22 Sorajja P, Cabalka AK, Hagler DJ, et al. Percutaneous repair of paravalvular prosthetic regurgitation: acute and 30day outcomes in 115 patients. Circ Cardiovasc Interv 2011;4:314–21. 23 Ruiz CE, Jelnin V, Kronzon I, et al. Clinical outcomes in patients undergoing percutaneous closure of periprosthetic paravalvular leaks. J Am Coll Cardiol 2011;58:2210–7. 24 Millán X, Bouhout I, Nozza A, et al. Surgery Versus Transcatheter Interventions for Significant Paravalvular Prosthetic Leaks. JACC Cardiovasc Interv 2017;10:1959–69. 25 Sorajja P, Cabalka AK, Hagler DJ, et al. The learning curve in percutaneous repair of paravalvular prosthetic regurgitation: an analysis of 200 cases. JACC Cardiovasc Interv 2014;7:521–9. 26 Lancellotti P, Pibarot P, Chambers J, et al. Recommendations for the imaging assessment of prosthetic heart valves: a report from the European Association of Cardiovascular Imaging endorsed by the Chinese Society of Echocardiography, the InterAmerican Society of Echocardiography, and the Brazilian Department of Cardiovascular Imaging . Eur Heart J Cardiovasc Imaging 2016;17:589–90. 27 Hascoet S, Smolka G, Bagate F, et al. Multimodality imaging guidance for percutaneous paravalvular leak closure: insights from the multicentre FFPP register. Arch Cardiovasc Dis 2018;111:421–31. 28 Lesser JR, Han BK, Newell M, et al. Use of cardiac CT angiography to assist in the diagnosis and treatment of aortic prosthetic paravalvular leak: a practical guide. J Cardiovasc Comput Tomogr 2015;9:159–64. 29 Suh YJ, Hong GR, Han K, et al. Assessment of mitral paravalvular leakage after mitral valve replacement using cardiac computed tomography: comparison with surgical findings. Circ Cardiovasc Imaging 2016;9. 30 de Agustin JA, JimenezQuevedo P, NombelaFranco L, et al. Paravalvular mitral leak closure under EcoXray fusion guidance. Eur Heart J Cardiovasc Imaging 2018;19:586. 31 Faletra FF, Pozzoli A, Agricola E, et al. Echocardiographicfluoroscopic fusion imaging for transcatheter mitral valve repair guidance. Eur Heart J Cardiovasc Imaging 2018;19:715–26. 32 Gafoor S, Steinberg DH, Franke J, et al. Tools and techniques--clinical: paravalvular leak closure. EuroIntervention 2014;9:1359–63. 33 Calvert PA, Northridge DB, Malik IS, et al. Percutaneous device closure of paravalvular leak: combined experience from the United Kingdom and Ireland. Circulation 2016;134:934–44. 34 García E, Arzamendi D, JimenezQuevedo P, et al. Outcomes and predictors of success and complications for paravalvular leak closure: an analysis of the Spanish realworld paravalvular leaks closure (HOLE) registry. EuroIntervention 2017;12:1962–8. 35 AnguloLlanos R, SarnagoCebada F, Rivera AR, et al. Twoyear follow up after surgical","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1011 - 1074"},"PeriodicalIF":0.0,"publicationDate":"2022-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43925789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guideline-directed medical therapy after transcatheter edge-to-edge mitral valve repair","authors":"Tetsu Tanaka, R. Kavsur, M. Spieker, C. Iliadis, C. Metze, Birthe M Brachtendorf, P. Horn, C. Zachoval, A. Sugiura, M. Kelm, S. Baldus, G. Nickenig, R. Westenfeld, R. Pfister, M. Becher","doi":"10.1136/heartjnl-2022-320826","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-320826","url":null,"abstract":"Objective A sizeable proportion of patients with secondary mitral regurgitation (SMR) do not receive guideline-directed medical therapy (GDMT) for heart failure (HF). We investigated the association between the use of GDMT and mortality in patients with SMR who underwent transcatheter edge-to-edge repair (TEER). Methods We retrospectively analysed patients with SMR and a left ventricular ejection fraction of <50% who underwent TEER at three centres. According to current HF guidelines, GDMT was defined as triple therapy consisting of beta-blockers, renin–angiotensin system (RAS) inhibitors and mineralocorticoid receptor antagonists (MRAs). Patients were divided into two groups: GDMT and non-GDMT groups. We calculated the propensity scores and carried out inverse probability of treatment weighting (IPTW) analyses to compare 2-year mortality between the two groups. Results Of 463 patients, 228 (49.2%) were treated with GDMT upon discharge. IPTW-adjusted Kaplan-Meier curve showed patients with GDMT had a lower incidence of mortality than those without GDMT (19.8% vs 31.1%, p=0.011). In IPTW-adjusted Cox proportional hazards analysis, GDMT was associated with a reduced risk of 2-year mortality (HR: 0.58; 95% CI: 0.35 to 0.95; p=0.030), which was consistent among clinical subgroups. Moreover, patients with GDMT had a higher rate of left ventricular reverse remodelling at 1 year after TEER than those without GDMT. Conclusion GDMT, defined as triple therapy consisting of beta-blockers, RAS inhibitors and MRAs, was associated with a reduced risk of 2-year mortality after TEER for SMR. Optimisation of medical therapy is crucial to improve clinical outcomes in patients undergoing TEER for SMR.","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1722 - 1728"},"PeriodicalIF":0.0,"publicationDate":"2022-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48787144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disparities in cardiovascular maternal health","authors":"Janet I Ma, D. Defaria Yeh, Ada C. Stefanescu Schmidt","doi":"10.1136/heartjnl-2022-321056","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-321056","url":null,"abstract":"While global maternal mortality has decreased in the last three decades, pregnancyrelated deaths remain prevalent in the USA, even after accounting for possible overreporting based on changes in death certificates. In 2017, approximately 17 US mothers per 100 000 live births died due to complications related to pregnancy or childbirth; in contrast, only 7 UK mothers per 100 000 live births died that year. Up to twothirds of US maternal deaths may have been preventable. Cardiovascular disease has emerged as the driving cause of current maternal mortality rates, causing or related to over onethird of US maternal deaths, with most deaths occurring during or after delivery. Recent studies worldwide have also begun to elucidate the longterm consequences of pregnancyrelated cardiovascular conditions such as gestational hypertension or preeclampsia 6 ; for instance, a largescale population study in the UK found hypertensive disorders of pregnancy increased risk across a multitude of cardiovascular disorders with the impact starting soon after pregnancy. In the USA, preeclampsiarelated deaths have decreased in the last two decades, while deaths associated with or due to chronic hypertension have been increasing. However, one striking difference between the USA and similarly wealthy countries, which may contribute to rising maternal mortality, is its fragmented insurance coverage. Marschner et al give readers a revealing snapshot of the intersection between cardiovascular maternal health and insurance coverage in an important and unique US demographic, pregnant women covered under Medicaid. As the US public insurance programme aimed to improve access to basic healthcare for those otherwise cannot afford it, Medicaid plays a pivotal role in supporting pregnant women living in poverty and currently provides coverage for half of all US births. Marschner et al take a deeper dive into the Medicaid population by exploring pregnancyrelated cardiovascular conditions and early postnatal adverse outcomes among Medicaidinsured pregnant women in three states in the USA between 2015 and 2019. They found that a striking onefourth of these women were diagnosed with a pregnancyrelated cardiometabolic condition, including hypertensive disorders of pregnancy and gestational or preexisting diabetes. Furthermore, between pregnancy and 60 days after delivery, over onetenth of these women were found to have a severe cardiovascular outcome, including heart failure, pulmonary embolism, stroke, cardiac arrest and myocardial infarction. Their study concluded that any type of pregnancyrelated cardiometabolic condition is associated with a threefold higher risk of a severe cardiovascular outcome. Marschner et al point out that current literature suggests the Medicaid population is at much higher risk of pregnancyrelated cardiometabolic conditions compared with those who have private insurance. Their analysis is based on claims data submitted to one Medicaid management company (the m","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1504 - 1505"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41915736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical profile and outcome of recurrent infective endocarditis","authors":"R. Citro, K. Chan, M. Miglioranza, C. Laroche, R. Benvenga, S. Furnaz, J. Magne, C. Olmos, B. Paelinck, A. Pasquet, C. Piper, A. Salsano, A. Savouré, S. Park, P. Szymański, P. Tattevin, N. Vallejo Camazón, P. Lancellotti, G. Habib","doi":"10.1136/heartjnl-2021-320652","DOIUrl":"https://doi.org/10.1136/heartjnl-2021-320652","url":null,"abstract":"Aims Purpose of this study is to compare the clinical course and outcome of patients with recurrent versus first-episode infective endocarditis (IE). Methods Patients with recurrent and first-episode IE enrolled in the EUROpean ENDOcarditis (EURO-ENDO) registry including 156 centres were identified and compared using propensity score matching. Recurrent IE was classified as relapse when IE occurred ≤6 months after a previous episode or reinfection when IE occurred >6 months after the prior episode. Results 3106 patients were enrolled: 2839 (91.4%) patients with first-episode IE (mean age 59.4 (±18.1); 68.3% male) and 267 (8.6%) patients with recurrent IE (mean age 58.1 (±17.7); 74.9% male). Among patients with recurrent IE, 13.2% were intravenous drug users (IVDUs), 66.4% had a repaired or replaced valve with the tricuspid valve being more frequently involved compared with patients with first-episode IE (20.3% vs 14.1%; p=0.012). In patients with a first episode of IE, the aortic valve was more frequently involved (45.6% vs 39.5%; p=0.061). Recurrent relapse and reinfection were 20.6% and 79.4%, respectively. Staphylococcus aureus was the microorganism most frequently observed in both groups (p=0.207). There were no differences in in-hospital and post-hospitalisation mortality between recurrent and first-episode IE. In patients with recurrent IE, in-hospital mortality was higher in IVDU patients. Independent predictors of poorer in-hospital and 1-year outcome, including the occurrence of cardiogenic and septic shock, valvular disease severity and failure to undertake surgery when indicated, were similar for recurrent and first-episode IE. Conclusions In-hospital and 1-year mortality was similar in patients with recurrent and first-episode IE who shared similar predictors of poor outcome.","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1729 - 1736"},"PeriodicalIF":0.0,"publicationDate":"2022-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49278776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute native aortic regurgitation: clinical presentation, diagnosis and management","authors":"J. Voit, C. Otto, Christopher R. Burke","doi":"10.1136/heartjnl-2021-320157","DOIUrl":"https://doi.org/10.1136/heartjnl-2021-320157","url":null,"abstract":"© Author(s) (or their employer(s)) 2022. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION Acute native valve aortic regurgitation (AR) is a rapidly fatal condition resulting from the sudden loss of valve competency. Acute AR requires prompt intervention yet often is missed because the clinical presentation is not recognised. The large volume of retrograde diastolic flow into a left ventricle (LV) without compensatory dilation results in an abrupt decrease in cardiac output and increase in LV enddiastolic pressure (figure 1). Urgent surgical intervention to restore valve competency and treat the underlying cause is essential. Options for medical stabilisation or palliative care are limited. This review covers the aetiology, haemodynamics, clinical presentation, diagnosis, medical stabilisation and surgical management of patients with acute native valve AR.","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1651 - 1660"},"PeriodicalIF":0.0,"publicationDate":"2022-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43670743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fractional flow reserve-guided percutaneous coronary intervention: aligning purpose, threshold and utility.","authors":"Jithendra Bernal Somaratne","doi":"10.1136/heartjnl-2022-321138","DOIUrl":"10.1136/heartjnl-2022-321138","url":null,"abstract":"","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46483517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adverse events after spontaneous coronary artery dissection","authors":"R. Graham","doi":"10.1136/heartjnl-2022-321136","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-321136","url":null,"abstract":"Spontaneous coronary artery dissection (SCAD) is an infrequent but increasingly recognised cause of acute coronary syndrome (ACS) that predominantly affects relatively young women aged 45–52 years and may even occur in association with pregnancy, where it is the most common cause of a myocardial infarction. 2 In contrast to ACS due to atherosclerotic disease, SCAD sufferers have few traditional risk factors apart from hypertension, and the pathophysiology involves impaired coronary flow, not due to plaque rupture, plaque erosion or thrombus formation associated with a calcific nodule, as is the case for atherosclerotic disease, but to the spontaneous formation of an intramural haematoma (IMH) that causes dissection of the vessel wall medial layer. The IHM is likely due to vasa vasorum rupture with or without an intimal tear. As the IMH expands, it compresses the ipsilateral coronary artery wall against the contralateral wall, thereby occluding the coronary lumen and results in ischaemia or infarction of the subtended myocardium. While much has been learnt about the clinical presentation and sequelae of SCAD from studies of retrospective and ambispective registries, metaanalyses and prospective cohorts, major gaps in our understanding of disease mechanisms, management and outcomes persist, with little prospective data from large cohorts and lack of data from randomised control studies. GarciaGuimaraes and colleagues report on the treatment and clinical outcomes of SCAD determined in a cohort of 389 patients assembled from The Spanish Registry on SCAD involving subjects from 34 hospitals. Although the study uses a nonrandomised observational design, particular strengths are its prospective nature, the reasonably large size of the cohort assembled, its careful documentation of SCAD diagnosis by a central angiography reading group and the use of an independent clinical events committee to evaluate adverse outcomes. Moreover, although the study has limitations, as duly acknowledged by the authors, and sheds little new light on the optimal management of SCAD, it does yield important new hypothesisgenerating findings that warranted confirmation in future controlled studies. The study confirms that for those patients who survive to hospital admission, the overall prognosis is favourable, with a survival at discharge of 98%, and 6% suffering a major inhospital adverse cardiovascular event (MAE), mainly driven by reinfarction or unplanned revascularisation and 13% developing a major adverse cardiovascular or cerebrovascular event (MACCE) over a median followup of 2 years. Of course, the outcomes of SCAD sufferers prior to hospitalisation remains unknown, and undoubtedly, some succumb to the disorder. Although the inhospital outcomes reported by GarciaGuimaraes et al are confirmatory, if not better than those reported by others, the MAEs and MACCEs reported did not include the considerable psychosocial burden associated with SCAD, including insomnia, anxiet","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1506 - 1507"},"PeriodicalIF":0.0,"publicationDate":"2022-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46720459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thinking outside the box: clinical and economic implications of extracardiac findings on cardiac computed tomography angiography","authors":"E. Hulten, V. Murthy","doi":"10.1136/heartjnl-2022-321009","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-321009","url":null,"abstract":"Kelion et 1 report a cross- sectional study of the incidence of non- cardiac incidental findings on 4340 clinically indicated coronary CT angiography (CCTA). The first and most significant finding is that 15.8% of CCTA examinations contained an incidental finding, although 23.6% were previously known (12.1% newly recognised incidental findings). A large proportion of these findings, 43%, were pulmonary nodules or cysts of unclear clinical significance. While these incidentals would not otherwise have been diag-nosed by screening criteria, their identification often does impose a burden on patients and medical systems without prognostic benefit. Second, most incidentals, but not all, could be identified on a cardiac field of view (FOV) image, without a need for a wide FOV reconstruction as per routine at many centres. The authors suggest this finding could support a rationale to more expeditiously evaluate only the cardiac FOV dataset in resource- limited settings, given the added time and cost burden of requiring a radiologist to review the full FOV scan for incidentals. Currently, as Kelion et al have noted, the minimum recommendation evaluate the cardiac Society Cardiovascular 1 4 could be detected on limited cardiac FOV vs on wide FOV","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":"1426 - 1427"},"PeriodicalIF":0.0,"publicationDate":"2022-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48906950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Baseline platelet count in percutaneous coronary intervention: a dose-response meta-analysis.","authors":"Akhmetzhan Galimzhanov, Yersyn Sabitov, Erhan Tenekecioglu, Han Naung Tun, Mirvat Alasnag, Mamas A Mamas","doi":"10.1136/heartjnl-2022-320910","DOIUrl":"10.1136/heartjnl-2022-320910","url":null,"abstract":"<p><strong>Objectives: </strong>The nature of the relationship between baseline platelet count and clinical outcomes following percutaneous coronary intervention (PCI) is unclear. We undertook dose-response and pairwise meta-analyses to better describe the prognostic value of the initial platelet count and clinical endpoints in patients after PCI.</p><p><strong>Methods: </strong>A search of PubMed, Scopus and Web of Science (up to 9 October 2021) was performed to identify studies that evaluated the association between platelet count and clinical outcomes following PCI. The primary outcomes of interest were all-cause mortality, major adverse cardiovascular events (MACE) and major bleeding. We performed random-effects pairwise and one-stage dose-response meta-analyses by calculating HRs and 95% CIs.</p><p><strong>Results: </strong>The meta-analysis included 19 studies with 217 459 patients. We report a J-shaped relationship between baseline thrombocyte counts and all-cause death, MACE and major bleeding at follow-up. The risk of haemorrhagic events exceeded the risk of thrombotic events at low platelet counts (<175×10⁹/L), while a predominant ischaemic risk was observed at high platelet counts (>250×10⁹/L). Pairwise meta-analyses revealed a robust link between initial platelet counts and the risk of postdischarge all-cause mortality, major bleeding (for thrombocytopenia: HR 1.39, 95% CI 1.30 to 1.49; HR 1.51, 95% CI 1.15 to 2.00, respectively) and future death from any cause and MACE (thrombocytosis: HR 1.60, 95% CI 1.29 to 1.98; HR 1.47, 95% CI 1.22 to 1.78, respectively).</p><p><strong>Conclusion: </strong>Low platelet counts were associated with the predominant bleeding risk, while high platelet counts were only associated with the ischaemic events.</p><p><strong>Prospero registration number: </strong>CRD42021283270.</p>","PeriodicalId":9311,"journal":{"name":"British Heart Journal","volume":"108 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46120096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}