ObjectiveTo analyze systematic reviews (SRs) and meta-analyses on the efficacy of pharmacological interventions in the prevention of contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI). MethodsWe searched the PubMed, The Cochrane Library, EMbase, CNKI, CBM, WanFang Data, and VIP databases to identify SRs and meta-analyses on the pharmacological interventions aimed at preventing CI-AKI after PCI from inception of the databases to February 2022. Two researchers independently screened the literature and extracted data. The PRISMA statement, AMSTAR 2 tool, and GRADE system were adopted to evaluate the reporting quality, methodological quality, and evidence quality of the findings of the included SRs and meta-analyses. ResultsA total of 14 SRs and meta-analyses were identified. Among the drugs used were statins, N-acetylcysteine, sodium bicarbonate, Dan-hong injection, vitamins, salvianolate, adenosine antagonists, nicorandil, allopurinol, alprostadil, furosemide, trimetazidine, probucol, and brain natriuretic peptide. Most of the studies had relatively comprehensive coverage of the items, with the PRISMA scores ranging from 18 to 24.5. The main issues of reporting quality were protocol and registration, search, and funding. The methodological quality of the SRs and meta-analyses was generally low. Items 2 and 7 were the key items with poor scores, and the non-critical items with poor scores were items 3, 10, and 16. All drugs, except furosemide, decreased the incidence of CI-AKI. The quality of evidence ranged from medium to very low according to GRADE. Conclusion Most of the single drugs or drugs combined with hydration show the potential to prevent CI-AKI, however, the overall methodological quality of the included studies is relatively low, and the strength of evidence is generally low.
ObjectiveTo systematically review the correlation between the triglyceride-glucose index (TyG index) and pulse wave velocity (PWV) and explore the relationship between the TyG index and arterial stiffness (AS). MethodsThe PubMed, Embase, Web of Science, CBM, WanFang Data, and CNKI databases were searched to collect observational studies on the correlation between the TyG index and AS from inception to January 14, 2024. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias in the included studies. Meta-analysis was performed using RevMan 5.4 software. ResultsA total of 16 studies were included. The results of the meta-analysis showed that when the TyG index was used as a continuous variable to evaluate its correlation with AS based on brachial-ankle pulse wave velocity (baPWV) as the outcome parameter, individuals with high TyG index had higher baPWV compared to those with low TyG index (OR=1.48, 95%CI 1.27 to 1.72, P<0.001). Similar correlations were observed when the TyG index was used as a categorical variable to evaluate its correlation with AS (OR=1.85, 95%CI 1.67 to 2.04, P<0.001). When carotid-femoral pulse wave velocity (cfPWV) was used as the outcome parameter, individuals with high TyG index had higher cfPWV compared to those with low TyG index when the TyG index was used as a continuous variable (OR=1.47, 95%CI 1.11 to 1.95, P=0.008). Similar correlations were observed when the TyG index was used as a categorical variable to evaluate its correlation with AS (OR=1.34, 95%CI 1.21 to 1.48, P<0.001). Subgroup analysis results showed that when the TyG index was used as a continuous variable, the correlation between the TyG index and baPWV was independent of gender, age, participant characteristics, and study type. When the TyG index was used as a categorical variable, the correlation between the TyG index and baPWV was independent of age and participant characteristics. Using high baPWV to define AS, when the TyG index was used as a continuous variable to evaluate its impact on AS, individuals with high TyG index had a higher likelihood of AS compared to those with low TyG index (OR=1.51, 95%CI 1.36 to 1.67, P<0.001). Similar correlations were observed when the TyG index was used as a categorical variable to evaluate its correlation with AS (OR=1.81, 95%CI 1.48 to 2.21, P<0.001). Using high cfPWV to define AS, when the TyG index was used as a continuous variable to evaluate its impact on arterial stiffness, individuals with a high TyG index had a higher likelihood of AS compared to those with a low TyG index (OR=1.30, 95%CI 1.10 to 1.53, P=0.02). Similar correlations were observed when the TyG index was used as a categorical variable to evaluate its correlation with AS (OR=1.60, 95%CI 1.33 to 1.92, P<0.001). Subgroup analysis results showed that when the TyG index was used as a continuous variable, the correlation between the TyG index and AS was independent of gender, participant characteristics, age, hypertension, and diabetes. When the TyG index was used as a categorical variable, the correlation between the TyG index and AS was independent of gender, participant characteristics, age, and hypertension. ConclusionThere is a strong correlation between the TyG index and PWV, with a higher TyG index associated with increased PWV and greater risk of AS. The TyG index can serve as a simple alternative marker for early diagnosis of AS and guide clinical intervention. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
Objective To systematically review the angiographic predictors of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Methods The PubMed, EMbase, Cochrane Library, Web of Science, CBM, WanFang Data, and CNKI databases were electronically searched to collect observational studies on the angiographic predictors of CTO-PCI from inception to December 18, 2022. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was performed using RevMan 5.4 software. Results A total of 36 studies were included. The results of meta-analysis showed that the angiographic predictors of CTO-PCI included calcification (OR=1.92, 95%CI 1.49 to 2.47, P<0.01), occlusion length≥20mm (OR=1.80, 95%CI 1.26 to 2.57, P<0.01), bending>45° (OR=2.19, 95%CI 1.56 to 3.08, P<0.01), blunt stump (OR=1.53, 95%CI 1.08 to 2.16, P<0.01), ostial lesions (OR=2.27, 95%CI 1.34 to 3.85, P<0.01), proximal cap ambiguity (OR=2.27, 95%CI 1.40 to 3.68, P<0.01), side branch at proximal cap (OR=1.65, 95%CI 1.27 to 2.16, P<0.01), and J-CTO score≥3 (OR=2.53, 95%CI 1.53 to 4.16, P<0.01). Conclusion Current evidence indicates that calcification, occlusion length ≥20mm, bending>45°, blunt stump, ostial lesions, proximal cap ambiguity, side branch at proximal cap, and J-CTO score≥3 are the angiographic predictors of CTO-PCI. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.