Background: Monocyte to High Density Lipoprotein Ratio (MHR) is a new marker that has been associated with major adverse cardiovascular outcomes among STEMI patients. We sought to strengthen the association between MHR and mortality and major adverse cardiovascular events (MACEs) among STEMI patients who underwent primary percutaneous coronary intervention. Methods: Studies were included if they satisfied the following criteria:1) Observational Studies; 2) Adult patients with ST-elevation Myocardial Infarction (STEMI) who underwent primary percutaneous intervention (PCI); and 3) Reported data on mortality and major adverse cardiovascular events. Using MEDLINE, Clinical Key, Science Direct, Scopus, and Cochrane Central Register of Controlled Trials databases, a search for eligible studies was conducted until September 2017. Our primary outcome of interest was all-cause cardiovascular (CV) mortality. We also investigated the association between MHR and major adverse cardiovascular events (MACEs). Results: We identified 3 studies involving 2793 STEMI patients, showing that in STEMI patients who underwent primary PCI, a high admission MHR is associated with a significantly higher in-hospital mortality [RR 4.71, (95% CI 2.36 to 9.39, p < 0.00001] and in-hospital MACE [RR 1.90, (95% CI 1.44 to 2.50), p < 0.00001]. This significant association was not observed in long term mortality or MACE. Conclusion: A high admission MHR among STEMI patients who underwent primary PCI is associated with a higher in-hospital mortality and MACE. This novel marker can be used as an inexpensive and readily available tool for risk stratification.

BackgroundRed cell distribution width (RDW), a routine component of the complete blood count (CBC), measures variation in the size of circulating erythrocytes. It has been associated with several clinical outcomes in cardiovascular disease. We sought to strengthen the association between RDW and mortality in patients admitted for acute coronary syndrome (ACS) by pooling together data from available studies.MethodsStudies that fulfilled the following were identified for analysis: 1) observational; 2) included patients admitted for ACS; 3) reported data on all-cause or cardiovascular (CV) mortality in association with a low or high RDW; and 4) used logistic regression analysis to control for confounders. Using MEDLINE, Clinical Key, ScienceDirect, Scopus, and Cochrane Central Register of Controlled Trials databases, a search for eligible studies was conducted until January 9, 2017. The quality of each study was evaluated using the Newcastle-Ottawa Quality Assessment Scale. Our primary outcome of interest was all-cause or CV mortality. We also investigated the impact of RDW on major adverse cardiovascular events (MACEs) for the studies that reported these outcomes. Review Manager (RevMan) 5.3 was utilized to perform Mantel-Haenzel analysis of random effects and compute for relative risk.ResultsWe identified 13 trials involving 10,410 patients, showing that in ACS, a low RDW is associated with a statistically significant lower all-cause or CV mortality (RR 0.35, (95% CI 0.30 to 0.40), P < 0.00001, I2 = 53%), a finding that was consistent both in the short- and long-term.ConclusionsA low RDW is also associated with lower risk for MACEs after an ACS (RR 0.56, (95% CI 0.51 to 0.61), P < 0.00001, I2 = 91%). A low RDW during an ACS is associated with lower all-cause or CV mortality and lower risk of subsequent MACEs, providing us with a convenient and inexpensive risk stratification tool in ACS patients.

BackgroundSymptoms of mitral stenosis (MS) are worsened during tachycardia and exercise. Beta-blockers are used in controlling heart rate (HR) in MS, resulting in symptom improvement, but coming with significant side effects. Ivabradine has a selective action on the sinus node devoid of the usual side effects of beta-blockers. Small studies have recently investigated the role of ivabradine in MS in sinus rhythm. Our aim was to determine the efficacy of ivabradine, compared to beta-blockers, in terms of exercise duration, maximum HR achieved, resting HR, mean gradient, and working capacity among patients with MS in sinus rhythm.MethodsWe conducted a systematic search of studies using MEDLINE, Google Scholar, ScienceDirect, Scopus, Clinical Key, Cochrane, and clinicaltrials.gov databases in all languages and examined reference lists of studies. We included studies if they are: 1) randomized controlled trials comparing ivabradine and beta-blockers; 2) of adults ≥ 19 years old with MS in sinus rhythm; and 3) reported data on exercise duration, maximum HR achieved, resting HR, mean gradient, and working capacity. Studies identified were assessed for risk of bias using the Cochrane Collaboration Tool for Assessing Risk of Bias. We used inverse variance analysis of fixed effects to compute for mean difference, carried out using Review Manager (RevMan) 5.3.ResultsPooled analysis from five identified trials showed that among patients with MS in sinus rhythm, ivabradine was better compared to beta-blockers in total exercise duration (mean difference: 32.73 s (95% CI: 12.19, 53.27; P = 0.002; I2 = 0%)), maximum HR achieved after exercise (mean difference: -3.87 beats per minute (95% CI: -5.88, -1.860; P = 0.0002; I2 = 23%)), and work capacity (mean difference: 0.56 METS (95% CI: 0.33, 0.80; P < 0.00001; I2 = 0%)); inferior to beta-blockers in resting HR achieved (mean difference: 1.83 s (95% CI: 0.39, 3.28; P = 0.01; I2 = 91%)); and comparable to beta-blockers in terms of mean gradient (mean difference: -0.52 mm Hg (95% CI: -1.20, 0.16; P = 0.13; I2 = 6%)).ConclusionsIvabradine is better or comparable to beta-blockers in terms of the outcomes measured, and may be considered as an alternative for patients with MS in sinus rhythm who are intolerant to beta-blockers.

Background  Several studies have suggested that hypochloremia is associated with adverse outcomes among patients with heart failure. The association appears to be more marked in those with acute decompensation. Research Question: What is the association of hypochloremia with mortality and worsening heart failure among patients in acute decompensation? Objective Determine the association of admission hypochloremia to all-cause mortality, heart failure death and worsening heart failure among patients with acute decompensated heart failure. Criteria for Inclusion of Studies: Studies were included if they satisfied the following criteria 1) observational cohort studies; 2) included patients admitted for acute decompensated heart failure; and 3) reported data on mortality and worsening heart failure in association with admission hypochloremia. Methods A systematic search using MEDLINE, Clinical Key, ScienceDirect, Scopus, and Cochrane Central Register of Controlled Trials databases was done, from June 2018 to January 31, 2019. The characteristics of included studies were collated. Data abstraction and quality assessment, using the Newcastle-Ottawa Quality Assessment Scale, were done independently by two reviewers, and disagreements were settled by a third reviewer. Review Manager (RevMan) 5.3 was utilized to perform Mantel-Haenzel analysis of random effects and compute for relative risk. Results We included three high quality cohort studies involving 3,444 patients admitted for acute decompensated heart failure and having low serum chloride levels on admission. Our study shows that admission hypochloremia is associated with increased risk for all-cause mortality [RR 1.63, (95% CI 1.60 to 2.28, p &lt; 0.00001]. Risks for heart failure death as mentioned in one study and worsening heart failure also in one study are likewise increased with hypochloremia on admission.  Conclusion Admission hypochloremia is associated with higher all-cause mortality among patients admitted for acute decompensated heart failure. The risk for heart failure death and worsening heart failure are also increased. Admission hypochloremia may be a useful prognosticator for heart failure patients.

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