Early Invasive Strategy and In‐Hospital Survival Among Diabetics With Non‐ST‐Elevation Acute Coronary Syndromes: A Contemporary National Insight

Background: There are limited data on the merits of an early invasive strategy in diabetics with non‐ST‐elevation acute coronary syndrome, with unclear influence of this strategy on survival. The aim of this study was to evaluate the in‐hospital survival of diabetics with non‐ST‐elevation acute coronary syndrome treated with an early invasive strategy compared with an initial conservative strategy. Methods and Results: The National Inpatient Sample database, years 2012–2013, was queried for diabetics with a primary diagnosis of non‐ST‐elevation acute coronary syndrome defined as either non‐ST‐elevation myocardial infarction or unstable angina (unstable angina). An early invasive strategy was defined as coronary angiography±revascularization within 48 hours of admission. Propensity scores were used to assemble a cohort managed with either an early invasive or initial conservative strategy balanced on \u3e50 baseline characteristics and hospital presentations. Incidence of in‐hospital mortality was compared in both groups. In a cohort of 363 500 diabetics with non‐ST‐elevation acute coronary syndrome, 164 740 (45.3%) were treated with an early invasive strategy. Propensity scoring matched 21 681 diabetics in both arms. Incidence of in‐hospital mortality was lower with an early invasive strategy in both the unadjusted (2.0% vs 4.8%; odds ratio [OR], 0.41; 95% CI, 0.39–0.42; P\u3c0.0001) and propensity‐matched models (2.2% vs 3.8%; OR, 0.57; 95% CI, 0.50–0.63; P\u3c0.0001). The benefit was observed across various subgroups, except for patients with unstable angina (Pinteraction=0.02). Conclusions: An early invasive strategy may be associated with a lower incidence of in‐hospital mortality in patients with diabetes. The benefit of this strategy appears to be superior in patients presenting with non‐ST‐elevation myocardial infarction compared with unstable angina

Sex Differences in Trends and In-Hospital Outcomes among Patients with Critical Limb Ischemia: A Nationwide Analysis

Background Critical limb ischemia (CLI) represents the most severe form of peripheral artery disease and is associated with significant mortality and morbidity. Contemporary data comparing the sex differences in trends, revascularization strategies, and in-hospital outcomes among patients with CLI are scarce. Methods and Results Using the National Inpatient Sample database years 2002 to 2015, we identified hospitalizations for CLI. Temporal trends for hospitalizations for CLI were evaluated. The differences in demographics, revascularization, and in‐hospital outcomes between both sexes were compared. Among 2 400 778 CLI hospitalizations, 43.6% were women. Women were older and had a higher prevalence of obesity, hypertension, heart failure, and prior stroke. Women were also less likely to receive any revascularization (34.7% versus 35.4%, P\u3c 0.001), but the trends of revascularization have been increasing among both sexes. Revascularization was associated with lower in‐hospital mortality among women (adjusted odds ratio [OR], 0.76; 95% CI, 0.71–0.81) and men (adjusted OR, 0.69; 95% CI, 0.65–0.73). On multivariable analysis adjusting for patient‐ and hospital‐related characteristics as well as revascularization, women had a higher incidence of in‐hospital mortality, postoperative hemorrhage, need for blood transfusion, postoperative infection, ischemic stroke, and discharge to facilities compared with men. Conclusions In this nationwide contemporary analysis of CLI hospitalizations, women were older and less likely to undergo revascularization. Women had a higher incidence of in‐hospital mortality and bleeding complications compared with men. Sex‐specific studies and interventions are needed to minimize these gaps among this high‐risk population

Methodological rigor and temporal trends of cardiovascular medicine meta-analyses in highest-impact journals

Background Well-conducted meta-analyses are considered to be at the top of the evidence-based hierarchy pyramid, with an expansion of these publications within the cardiovascular research arena. There are limited data evaluating the trends and quality of such publications. The objective of this study was to evaluate the methodological rigor and temporal trends of cardiovascular medicine-related meta-analyses published in the highest impact journals. Methods and Results Using the Medline database, we retrieved cardiovascular medicine-related systematic reviews and meta-analyses published i

National Trends of Vascular Risk Factor Control Among Stroke Survivors: From the National Health and Nutrition Examination Survey 2009 to 2020

Background Contemporary data describing the national trends on vascular risk factor control among stroke survivors are limited. Methods and Results This is a cross‐sectional analysis of the National Health and Nutrition Examination Survey cycles 2009 to 2010 to 2017 to March 2020. Adults (≥18 years of age) with a self‐reported diagnosis of stroke were identified. Age‐adjusted trends in hypertension, diabetes, and hyperlipidemia control were examined. Sex and racial differences in vascular risk factor control were also investigated. Among 32 497 adult individuals who participated in the National Health and Nutrition Examination Survey, 1354 participants (4.2%) self‐reported a prior diagnosis of stroke (55% were women). The rates of age‐adjusted blood pressure control worsened when using the cutoff <140/90 mm Hg (79.1% in 2009–2010 versus 61.5% in 2017–March 2020, Ptrend<0.001) and using the cutoff <130/80 mm Hg (53.3% in 2009–2010 versus 38.6% in 2017–March 2020, Ptrend=0.006). Age‐adjusted diabetes control (hemoglobin A1c <7 mg/dL) did not significantly change during the study period (88.8% in 2009–2010 versus 85.9% in 2017–March 2020, Ptrend=0.41). Achieving a total cholesterol level <200 mg/dL did not change during the study period (67.3% in 2009–2010 versus 73.3% in 2017–March 2020, Ptrend=0.16). These findings were mostly consistent in men and women and across the different racial and ethnic groups. Conclusions In the United States, secondary prevention was suboptimal for stroke survivors, and there has not been any major significant improvement in the rates of achieving the recommended targets for vascular risk factors during the past decade. These findings highlight the need for targeted interventions to improve these modifiable risk factors

Cardiovascular Abnormalities Among Patients with Spontaneous Subarachnoid Hemorrhage. A Single Center Experience

Objective: To assess the cardiovascular abnormalities in patients with spontaneous subarachnoid hemorrhage (SAH). Methods: All patients admitted to our institution with a primary diagnosis of spontaneous SAH and had a transthoracic echocardiogram (TTE) performed from 1st of July 2011 until 30th of May 2014 were enrolled. Results: Out of 2058 patients admitted to our institution with a diagnosis of SAH, over a three year period, only 244 patients (12%) had TTE performed during the index hospitalization. In this selected cohort, the mean age was 59 years and 66% of patients were female. Elevated troponin T was noticed in 37% of patients and QTc prolongation was the commonest ECG abnormality occurring in 49% of the patients. Thirty nine patients (16%) had a resting segmental wall motion abnormality on the TTE, including five patients with apical ballooning. In-hospital mortality was 15.6% (38 patients). Conclusion: Cardiovascular abnormalities in selected patients with SAH who had cardiac ultrasound are relatively common; however the incidence of ventricular ballooning is low. In order to attain the correct incidence of cardiovascular abnormalities in SAH patients, all patients admitted with SAH should undergo TTE and have ECG and cardiac markers checked during their hospitalization

Meta-Analysis on the Clinical Outcomes With Polypills for Cardiovascular Disease Prevention

Randomized controlled trials (RCTs) examining the outcomes of “polypill” therapy in cardiovascular disease prevention have yielded mixed results. We performed an electronic search through January 2023 for RCTs that examined the use of polypills for cardiovascular disease primary or secondary prevention. The primary outcome was the incidence of major adverse cardiac and cerebrovascular events (MACCEs). The final analysis included 11 RCTs with 25,389 patients; 12,791 patients were in the polypill arm, and 12,598 patients were in the control arm. The follow-up period ranged from 1 to 5.6 years. Polypill therapy was associated with a lower risk of MACCE (5.8% vs 7.7%; risk ratio [RR] 0.78, 95% confidence interval [CI] 0.67 to 0.91). The reduction of MACCE risk was consistent in both primary and secondary prevention. Polypill therapy was associated with a lower incidence of cardiovascular mortality (2.1% vs 3%; RR 0.69, 95% CI 0.55 to 0.87), myocardial infarction (2.3% vs 3.2%; RR 0.72, 95% CI 0.61 to 0.84) and stroke (0.9% vs 1.6%; RR 0.62, 95% CI 0.42 to 0.90). Polypill therapy was associated with a higher degree of adherence. There was no difference between both groups in the incidence of serious adverse events (16.1% vs 15.9%; RR 1.12, 95% CI 0.93 to 1.36). In conclusion, we found that a polypill strategy was associated with a lower incidence of cardiac events and higher adherence, without an increased incidence of adverse events. This benefit was consistent for both primary and secondary prevention

Sex differences in trends and in-hospital outcomes among patients with critical limb ischemia: A nationwide analysis

BACKGROUND: Critical limb ischemia (CLI) represents the most severe form of peripheral artery disease and is associated with significant mortality and morbidity. Contemporary data comparing the sex differences in trends, revascularization strategies, and in-hospital outcomes among patients with CLI are scarce. METHODS AND RESULTS: Using the National Inpatient Sample database years 2002 to 2015, we identified hospitalizations for CLI. Temporal trends for hospitalizations for CLI were evaluated. The differences in demographics, revascularization, and in-hospital outcomes between both sexes were compared. Among 2 400 778 CLI hospitalizations, 43.6% were women. Women were older and had a higher prevalence of obesity, hypertension, heart failure, and prior stroke. Women were also less likely to receive any revascularization (34.7% versus 35.4%, P\u3c0.001), but the trends of revascularization have been increasing among both sexes. Revascularization was associated with lower in-hospital mortality among women (adjusted odds ratio [OR], 0.76; 95% CI, 0.71– 0.81) and men (adjusted OR, 0.69; 95% CI, 0.65– 0.73). On multivariable analysis adjusting for patient-and hospital-related characteristics as well as revascularization, women had a higher incidence of in-hospital mortality, postoperative hemorrhage, need for blood transfusion, postoperative infection, ischemic stroke, and discharge to facilities compared with men. CONCLUSIONS: In this nationwide contemporary analysis of CLI hospitalizations, women were older and less likely to undergo revascularization. Women had a higher incidence of in-hospital mortality and bleeding complications compared with men. Sex-specific studies and interventions are needed to minimize these gaps among this high-risk population