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The risk of gastrointestinal bleeding in patients taking third-generation P2Y12 inhibitors compared with clopidogrel: systematic review and meta-analysis.
No full textBACKGROUND: Dual antiplatelet therapy is an essential component in the management of acute coronary syndrome (ACS) but with a significant risk of bleeding. Newer third-generation P2Y12 inhibitors have proven to be more efficacious but have increased the risk of bleeding. This meta-analysis will study the difference in risk of gastrointestinal bleeding in clopidogrel vs. third-generation oral P2Y12 inhibitors.
METHODS: A literature search was done in two databases (PubMed/Medline and Cochrane Central). All studies meeting the inclusion criteria assessing the occurrence of gastrointestinal bleeding following the use of oral third-generation P2Y12 inhibitors or clopidogrel were systematically identified. A random-effects meta-analysis evaluated the two arms\u27 risk ratios (RR).
RESULTS: A total of 16 studies were included in our analysis, 11 of which compared ticagrelor to clopidogrel and 5 of which compared prasugrel to clopidogrel. The combined risk for both third-generation P2Y12 inhibitors, Ticagrelor and Prasugrel, was as follows [RR: 1.31 (1.15-1.49);
CONCLUSION: Oral third-generation P2Y12 inhibitors were associated with an increased occurrence of gastrointestinal bleeding compared to clopidogrel
Periprocedural Outcomes of VT Ablation in Ischemic Compared to Non-Ischemic Dilated Cardiomyopathy.
No full textBACKGROUND: Patients with structural heart disease undergoing catheter ablation (CA) for VT have shown higher procedural-related adverse events. However, periprocedural outcomes comparing CA for VT in different cardiomyopathies are not well known. We aim to study short-term outcomes of CA in ischemic (ICM) compared to non-ischemic dilated cardiomyopathy (NIDCM).
METHODS: The national readmission database (2016-2020) was used to identify hospitalizations for CA for VT. Cohorts were stratified based on underlying cardiomyopathy. A Propensity Score Matching (PSM) model matched ICM to NIDCM patients. Pearson\u27s Chi-squared test was applied to PSM-matched cohorts to compare outcomes.
RESULTS: Among 7081 hospitalizations for VT ablation, 17.5% of patients had underlying NIDCM, while 82.5% of patients had ICM. On a PSM analysis (N: 3534), ICM patients had higher incidences of sudden cardiac arrest (SCA) (7.9% vs. 5.6%, p \u3c 0.001), major adverse cardiac events (11.1% vs. 9%, p: 0.006), and cardiogenic shock (10.8% vs. 8.5%, p: 0.001). Interestingly, NIDCM patients were found to have much higher rates of pericardial complications (6.09% vs. 1.90%, p \u3c 0.001), while the mortality difference was not significant (p \u3e 0.05). From 2016 to 2020, in-hospital mortality rates have not changed significantly in ICM and NIDCM cases admitted for VT ablation (p-trend \u3e 0.05); however, there was a decreasing trend of SCA cases in NIDCM hospitalizations (8.7%-3.4%, p-trend: 0.028). NIDCM patients had higher readmission rates at 30 days (18% vs. 15.5%, p: 0.01), 90-day (32.3% vs. 29.6%, p: 0.041), and 180-day (44% vs. 38.2%, p: 0.001).
CONCLUSION: VT ablation in ICM patients was associated with higher non-fatal periprocedural events. NIDCM patients showed higher all-cause readmission rates
Validation of a New AI Seizure Detection Algorithm for Pre-term Neonates, Term Neonates and Infants
No full textMachine learning predicts non-home discharge in patients treated for unruptured cerebral aneurysms
No full textTrends in Mortalities due to Sudden Cardiac Arrest in the United States Population.
No full textBACKGROUND: Sudden cardiac arrest is a leading cause of cardiovascular mortality, often occurring without warning and resulting in high fatality rates. Despite advances in prevention and emergency response, disparities in mortality remain rampant across demographic and geographic groups. This study examines long-term trends in sudden cardiac arrest-related mortality in the United States from 1999 to 2023, stratified by sex, race/ethnicity, region, and urbanization level.
METHODS: Mortality data was extracted from the CDC WONDER database. Age-adjusted mortality rates (AAMRs) were calculated per 100 000 persons using the 2000 U.S. standard population. Joinpoint regression analysis was applied to estimate annual percent changes (APCs) and identify significant shifts in mortality trends.
RESULTS: A total of 8 523 980 SCA deaths were reported during the study period. Overall, the AAMR declined from 196.03 in 1999 to 131.55 in 2023, with the most marked reductions observed after 2021 (APC: -9.63; 95% CI: -13.51 to -5.20;
CONCLUSIONS: Mortality due to sudden cardiac arrest has declined substantially over the past 25 years, likely driven by improvements in cardiovascular prevention, acute care, and resuscitation practices. However, significant sex, racial, and regional disparities persist, highlighting the need for interventions that are tailored to reduce inequities and improve survival from sudden cardiac arrest
Outpatient administration of epcoritamab monotherapy for relapsed/refractory diffuse large B-cell lymphoma (R/R DLBCL): Results from EPCORE NHL-6 by race and ethnicity
No full textInterim analysis of LimiTec, a prospective trial of limited-duration teclistamab for relapsed/refractory multiple myeloma
No full textClonal hematopoiesis of indeterminate potential- a potential risk factor for GI malignancies
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