Jonathan Ka-Ming Ho

This systematic review and network meta-analysis (NMA) evaluated the efficacy and safety of dual antiplatelet therapy (DAPT) and triple antiplatelet therapy (TAPT) in East Asian patients with acute coronary syndrome. Twenty-six randomized controlled trials comparing DAPT (P2Y12 inhibitor with aspirin) or TAPT (cilostazol with clopidogrel-based DAPT) were included from four databases. Primary outcomes were major adverse cardiac events (MACEs) and major bleeding events. Frequentist NMA was performed using RRs. The reference comparator was clopidogrel-based DAPT. TAPT significantly reduced MACEs without increasing major bleeding events. Standard-dose potent P2Y12 inhibitor-based DAPT showed no MACE reduction but significantly increased major bleeding events. TAPT had the highest probability of reducing MACEs, while DAPT incorporating potent P2Y12 inhibitors with de-escalation had the highest probability of minimizing major bleeding events. To conclude, TAPT demonstrates promising efficacy without compromising safety, while de-escalation strategies appear effective in balancing the efficacy and safety of DAPT.

Background: A novel handheld point-of-care high-sensitivity cardiac troponin I analyser has recently been introduced to the market. Evaluating its diagnostic performance against laboratory standards is imperative, given the variations in cardiac troponin levels across populations. This study compared the diagnostic performance between the point-of-care high-sensitivity cardiac troponin I assay (Siemens Healthineers Atellica VTLi) and a laboratory high-sensitivity cardiac troponin I assay (Abbott ARCHITECT STAT High Sensitive Troponin-I) performed using blood samples from various populations (overall, male, female, younger and older) of Chinese patients with chest pain. Methods: This cross-sectional study included 585 consecutive Chinese patients (age ≥18 year) who presented to an emergency department with chest pain (lasting >5 min) and were managed following the chest pain protocol between 1 August 2023 and 12 June 2024. For both assays, blood samples were collected at two time points (0 hour (initial) and 3 hour (subsequent)). The primary outcome was the diagnostic performance of the two assays, evaluated with their 99th percentile upper reference limits used as the cut-off values for diagnosing myocardial infarction. The gold standard for comparison was the final diagnoses made by attending physicians. Results: The point-of-care and laboratory assays exhibited equivalent sensitivity and negative predictive values (both 100%) for blood samples collected at both time points. However, the point-of-care assay outperformed the laboratory assay in terms of specificity (initial: 90.5% to 96.3% vs 79.8% to 94.7%; subsequent: 87.8% to 94.8% vs 77.7% to 92.4%) and positive predictive value (initial: 24.4% to 30.8% vs 11.6% to 23.5%; subsequent: 12.5% to 25.0% vs 5.9% to 18.8%), particularly in older patients. Conclusion: The point-of-care assay is recommended for rapid clinical decision-making. Future studies should explore the effects of its integration into clinical practice and the feasibility of using sex–race–age-specific 99th percentile upper reference limits to enhance its diagnostic performance.

Purpose: This systematic review (SR) of SRs evaluates the effectiveness of vasopressin alone or in combination with other drugs in improving the outcomes of cardiac arrest (CA). Methods: Using a three-step approach, we searched five databases to identify all relevant SRs. Two reviewers independently selected suitable studies, assessed study quality, and extracted relevant data. If an outcome was reported by multiple SRs, a re-meta-analysis was conducted as needed; otherwise, a narrative analysis was performed. Results: Twelve SRs covering 16 original studies were included in this review. The meta-analysis results revealed a significant increase in survival to hospital admission for patients with in-hospital CA (IHCA) or out-of-hospital CA (OHCA) receiving vasopressin alone compared with that for those receiving epinephrine alone. Furthermore, the return of spontaneous circulation (ROSC) was significantly increased in patients with OHCA receiving vasopressin with epinephrine compared with that in those receiving epinephrine alone. Compared with patients with IHCA receiving epinephrine with placebo, those receiving vasopressin, steroids, and epinephrine (VSE) exhibited significant increases in ROSC, survival to hospital discharge, favorable neurological outcomes, mean arterial pressure, renal failure–free days, coagulation failure–free days, and insulin requirement. Conclusion: VSE is the most effective drug combination for improving the short- and long-term outcomes of IHCA. It is recommended to use VSE in patients with IHCA. Future studies should investigate the effectiveness of VSE against OHCA and CA of various etiologies, the types and standard dosages of steroids for cardiac resuscitation, and the effectiveness of vasopressin–steroid in improving CA outcomes.