This study aims to identify the risk factors of re-intervention on targeted vessels after balloon pulmonary angioplasty (BPA) in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). We retrospectively analyzed consecutive patients with inoperable CTEPH undergoing BPA at a single center. Targeted vessels and patients were classified according to whether re-intervention occurred. Mixed-effects logistic regression with a patient-level random intercept was used to identify predictors of re-intervention. The optimal threshold was determined by ROC analysis. Time to re-intervention was described by vessel-level Kaplan–Meier curves, and model performance was evaluated using the C-statistic, bootstrap internal validation, calibration plots, and decision-curve analysis. We enrolled 62 patients with inoperable CTEPH who underwent 168 BPA sessions and 412 targeted vessels. Re-intervention occurred in 98/412 vessels (23.8

Background Pulmonary embolism (PE) as a preventable and potentially fatal noncommunicable disease was believed to have a lower incidence in Asian populations compared to Western populations. However, the incidence and mortality rates of PE in China and the impact of venous thromboembolism (VTE) prevention system constructions on PE still lack nationwide evidence. Methods For this nationwide hospital-based observational study, we used data from the National Hospital Quality Monitoring System (HQMS) and public database in China. We estimated the incidence and in-hospital mortality rates of PE by age group, sex, and regions of geographical and socioeconomic level. VTE prevention and management system constructions were quantified by geographical density. We then calculated the incidence and mortality rates in different conditions of VTE prevention and management system construction. Findings During the 12 months period between January and December 2021, a total number of 200,112 PE patients and 14,123 deaths were recorded from 5101 hospitals in the HQMS database. The incidence of PE was 14.19 (200,112, 95% CI 14.13-14.26) per 100,000 population and the mortality rate was 1.00 (95% CI 0.99-1.02) per 100,000 population. The incidence of PE was higher in male patients (14.43 per 100,000 population) than in female patients (13.95 per 100,000 population). Disparities of incidence and mortality rates were shown within age groups and geographical regions. The incidence and mortality rates of PE showed decreasing trend with increasing geographical density of VTE-related facilities and VTE prevention system developments. Interpretation China had a substantially large number of PE patients. The incidence and mortality rates of PE showed disparities in terms of sex, age, and geography. The incidence and mortality rates of PE decrease across regions with increasing levels of socioeconomic development, potentially influenced by the existing VTE prevention and management systems. Optimizing the health policies and healthcare investment in VTE prevention may help reduce the disease burden of PE. Funding CAMS Innovation Fund for Medical Sciences (CIFMS) (2023-I2M-A-014); National High Level Hospital Clinical Research Funding (2022-NHLHCRF-LX-01-0108); National Key Research and Development Program of China (2023YFC2507200); Discipline-Innovation and Talent-Introduction Program for Colleges and Universities (111 Plan, B23038). Copyright (c) 2024 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Background:Among patients with ST-elevation myocardial infarction (STEMI) and multivessel disease, whether fractional flow reserve (FFR) guided complete revascularization (CR) is superior to the now widely used culprit-only (COR) revascularization is unclear. Methods:We conducted a search of PubMed, Embase, the Cochrane Library, and CNKI for randomized controlled trials comparing FFR-guided CR with COR in STEMI patients with multivessel disease. Data extraction and analysis adhered to Cochrane guidelines, with major adverse cardiac events as the primary outcome. Results:This meta-analysis included 6 trials involving 3,482 patients. FFR-guided CR was associated with a reduction in major adverse cardiac events (RR: 0.66, 95% CI: 0.46-0.94, 95% PI: 0.20-2.19), ischemia-driven revascularization (RR: 0.27, 95% CI: 0.19-0.40, 95% PI: 0.16-0.46), and repeat percutaneous coronary interventions (RR: 0.35, 95% CI: 0.22-0.50, 95% PI: 0.16-0.78) compared to COR. However, no difference was observed in all-cause mortality (RR: 1.12, 95% CI: 0.86-1.46, 95% PI: 0.79-1.58) or safety outcomes. Conclusion:FFR-guided CR reduces major adverse cardiac events compared to COR, though benefits may vary across settings. It significantly lowers ischemia-driven revascularization and repeat percutaneous coronary interventions, with no difference in all-cause mortality compared to COR. Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/view/CRD42024567524, PROSPERO (CRD42024567524).

BACKGROUND:The prognostic value of platelet-lymphocyte ratio (PLR) in ischemic stroke had been investigated in previous studies. However, the results of studies on PLR in patients with intracranial hemorrhage (ICH) are inconsistent. We aimed to conduct a meta-analysis to determine the prognostic value of PLR in predicting functional outcome and mortality in patients with ICH. METHODS:We searched the databases of PubMed, Embase, the Cochrane Library, and CNKI for relevant studies up to 10th June 2024. The Newcastle Ottawa Quality Assessment Scale (NOS) was applied to evaluate the quality of the included studies. We calculated the pooled odds ratios (OR) with 95% confidence intervals (CI) between PLR and both functional outcome (as measured by the modified Rankin Scale, mRS) as well as mortality. Poor functional outcomes were defined as mRS > 2. RESULTS:A total of 6 studies with 2992 patients were included. The random effects meta-analysis demonstrated that elevated PLR exhibited an association with poor functional outcome in patients with ICH (OR = 1.69; 95% CI [1.39-2.07]; P<0.0001; I2 = 24%). Similarly, elevated PLR was associated with mortality in patients with ICH (OR = 1.65; 95% CI [1.12-2.43]; P = 0.01; I2 = 31%). CONCLUSION:This study suggested that elevated PLR was significantly associated with poor functional outcome (mRS>2) and increased mortality, indicating that elevated PLR could serve as a reliable a prognostic factor for unfavorable clinical outcomes in patients with ICH. It is advisable to conduct extensive prospective investigations across diverse ethnic backgrounds to verify the accuracy of this correlation prior to its utilization in clinical settings.

[This corrects the article DOI: 10.1016/j.lanwpc.2024.101258.].

Stroke poses a significant mortality threat and frequently results in survivors experiencing varying degrees of residual disability. The objective of this meta-analysis was to elucidate the association between C-reactive protein-to-albumin ratio (CAR) and prognosis in patients with stroke. We searched the databases of PubMed, Embase, the Cochrane Library, and CNKI for relevant studies up to 26th January 2024. The quality of the included studies was evaluated using the Newcastle Ottawa Quality Assessment Scale (NOS). Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated for the association between CAR and poor functional outcomes and mortality. A total of nine studies with 2954 patients were included. The pooled results demonstrated that elevated CAR was associated with poor functional outcomes in patients with stroke (OR: 2.24; 95% CI: 1.81-2.78; P < 0.00001). Similarly, elevated CAR was associated with mortality in patients with stroke (OR: 2.11; 95% CI: 1.51-2.94; P < 0.0001). CAR has prognostic value for poor functional outcomes and mortality in patients with stroke.

ObjectiveThis study aims to conduct a systematic review and network meta-analysis to evaluate the efficacy and safety of specific corticosteroids, including but not limited to hydrocortisone, methylprednisolone, prednisolone, and dexamethasone, in the treatment of severe community-acquired pneumonia (SCAP). Efficacy will be assessed using specific outcomes, such as 30-day mortality and the requirement for mechanical ventilation. Safety evaluations will include adverse events like gastrointestinal bleeding and healthcare-associated infections. The study seeks to address the gaps identified in the latest guidelines regarding the optimal use of different corticosteroid types and to provide recommendations for clinical practice.Data SourcesThis study conducted a comprehensive search of Medline, Embase, and the Cochrane Central Register of Controlled Trials, covering the period from inception until 22 June 2023. Randomized clinical trials for corticosteroid use among adults with SCAP were collected.Study SelectionTwo researchers independently assessed study eligibility based on titles and abstracts, with any disagreements resolved through discussion or consultation with a third researcher.Data ExtractionTwo researchers independently collected and clarified study details, with a third researcher adjudicating in case of disputes.Data SynthesisThe data from 13 randomized clinical trials involving 2,495 patients, were analyzed using a random-effects model. Eleven trials were assessed as low risk, while two were assessed as high risk. Trials were rated as having low bias risk. Results, presented as risk ratios (RR) with a 95% confidence interval (CI), indicated that hydrocortisone outperformed prednisolone (RR 0.35; 95% CI 0.10–0.94), methylprednisolone (RR 0.41; 95% CI 0.15–0.89), and placebo (RR 0.35; 95% CI 0.16–0.59) in reducing 30-day mortality. A rankogram plot suggested that hydrocortisone had the highest probability of being the most effective treatment for this outcome within the analyzed group.ConclusionIn this network meta-analysis, while hydrocortisone showed greater efficacy than prednisolone, methylprednisolone, and placebo in reducing 30-day mortality in patients with SCAP, further Randomized Controlled Trials (RCTs) are required to confirm these findings before drawing definitive conclusions.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=438389, identifier CRD42023438389.

Objective We aimed to investigate the potential role of heart-kidney crosstalk after normotensive pulmonary embolism (PE) and the impact of anticoagulation on renal function recovery in PE patients with/without right ventricle (RV) dysfunction. Design and Methods In a multicenter cohort study, data were collected from patients with acute PE. Patients without hemodynamic instability were analyzed. Demographics and RV function was assessed on admission. All available measurements of serum creatine (SCr) during hospitalization and follow-up were recorded to define acute kidney injury (AKI) by the KDIGO criteria. Occurrence and recovery of AKI were obtained and their associations with RV dysfunction and early anticoagulation were analyzed. Results In a total of 489 acute PE patients recruited, 461 (94.3%) were normotensive. A transient elevation of SCr was observed. The incidence of AKI among normotensive patients was 18.9%. In normotensive PE patients, BNP/NT-proBNP elevation (adjusted hazard ratio (aHR) 2.08, 95% confident interval (CI) 1.31-3.29) and history of chronic kidney disease (CKD) (aHR 3.76, 95%CI 2.03-6.95) were associated with the development of AKI during hospitalization. Initiating anticoagulation treatment within 5 days after PE onset promoted early recovery of AKI (adjusted risk ratio [aRR] 1.57, 95%CI 1.09-2.26), and those had both BNP/NT-proBNP elevation and RV failure detected by imaging test benefitted the most (aRR 3.76, 95%CI 1.17-12.12). Conclusions: Patients developed AKI would benefit from early anticoagulation therapy for an early recovery of renal function, especially among those comorbid with RV dysfunction.

Background: Perfluoroalkyl chemicals (PFCs) as possible cardiovascular disrupters are universally detected in humans. However, evidence from epidemiological studies appears insufficient and ambiguous. Objectives: We aim to examine the serum PFCs levels and their associations with the prevalence of cardiovascular diseases (CVD) and related outcomes in general US population. Methods: We investigated the serum levels of 12 major PFCs, including perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), 2-(N-ethyl-perfluorooctane sulfonamido) acetate (EPAH), 2-(N-methyl-perfluorooctane sulfonamido) acetate (MPAH), perfluorodecanoic acid (PFDE), perfluorobutane sulfonate (PFBS), perfluoroheptanoic acid (PFHP), perfluorononanoic acid (PFNA), perfluorooctane sulfonamide (PFSA), perfluoroundecanoic acid (PFUA), and perfluorododecanoic acid (PFDO), in 10,859 participants from the National Health and Nutritional Examination Survey (NHANES) 1999-2014. Logistic regression models were used to estimate the associations between serum PFCs and 5 self-reported CVD outcomes, including congestive heart failure, coronary heart disease, angina pectoris, heart attack, and stroke. Linear regression analyses were used to estimate the PFCs and their associations with 8 traditional CVD risk factors like serum triglyceride and total cholesterol. Results: In multivariable-adjusted models, total PFCs were positively associated with total CVD (p for trend = 0.0166), independent of traditional CVD risk factors, such as smoking status, diabetes, hypertension and serum cholesterol level. Compared with reference quartile of total PFCs levels, the multivariable adjusted odds ratios in increasing quartiles were 1.23 [95% confidence interval (CI): 0.91-1.66], 1.47 (95% CI: 1.14-1.89) and 1.45 (95% CI: 1.06-1.98) for total CVD. Similar positive associations were found if considering individual PFCs including PFOS, PFUA, MPAH, EPAH, PFDO, PFSA and PFBS. In addition, serum levels of MPAH and PFDO were positively associated with congestive heart failure; PFNA, PFDE, and PFUA were positively associated with coronary heart disease; PFUA and PFDO were positively associated with angina pectoris; and PFNA was positively associated with heart attack. Conclusions: Our findings suggested that exposure to PFCs was positively associated with risk of CVD. Further longitudinal studies are needed to increase our understanding about the role of PFCs exposure in the prevalence of CVD.