Browsing by Autor "Luis E. Cueva"

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Abstract 4339564: Evidence shows comparable efficacy of dual therapy with ticagrelor and aspirin versus monotherapy in peripheral arterial disease: A systematic review and meta-analysis of 1,702 patients
(Lippincott Williams & Wilkins, 2025) Claudia Martinez‐Tapia; Luis E. Cueva; Karoly Pamela Zuñiga Montaño; J. Ruiz
Peripheral artery disease (PAD) increases the risk of cardiovascular events, such as stroke and myocardial infarction. Antiplatelet therapy, particularly aspirin, has been essential in the management of PAD, although its effectiveness may be limited in high-risk patients. Recently, ticagrelor, a P2Y12 receptor inhibitor, has been shown to be an effective alternative or adjunctive treatment to aspirin. However, the optimal therapeutic strategy for PAD remains unclear, especially when comparing dual therapy with ticagrelor plus aspirin with monotherapy with either antiplatelet agent alone. While dual therapy has been shown to be effective in other cardiovascular diseases, its impact on PAD outcomes, particularly safety and efficacy, requires further investigation. A systematic search was performed in PubMed, Scopus, Embase, and Web of Science, following PRISMA guidelines, including studies up to March 19, 2025. We included only randomized controlled trials (RCTs) comparing the use of ticagrelor plus aspirin with monotherapy antiplatelet alone in patients with PAD. Our main outcomes were myocardial infarction, mortality, limb ischemia, and hemorrhagic events. Hazard Ratio (HR) with 95% Confidence Intervals (CI) were calculated using a random-effects model. Heterogeneity was assessed with I2 statistics. Three RCTs were included from 280 studies obtained through the search. In 1,702 patients, no statistically significant differences were found in myocardial infarction (HR: 1.18; 95% CI: 0.70-1.96; p=0.54), mortality (HR: 0.73; 95% CI: 0.49-1.08; p=0.12), limb ischemia (HR: 0.64; 95% CI: 0.39-1.05; p=0.08), and hemorrhagic events (HR: 1.27; 95% CI: 0.32-4.99; p=0.74) between dual therapy and monotherapy.This meta-analysis is the first to evaluate the comparative effectiveness of dual treatment with ticagrelor plus aspirin versus monotherapy with either antiplatelet agent alone in patients with PAD. Although the results indicated no statistically significant differences between the two treatment strategies in terms of myocardial infarction, mortality, limb ischemia, or bleeding events, the absence of a clear benefit of dual therapy suggests that monotherapy may be a reasonable approach for the management of PAD in these patients. However, given the limitations of this analysis, including the number of studies, further RCTs are necessary to confirm these findings and provide more definitive guidance on the optimal treatment strategy for PAD.
Abstract 4341436: Semaglutide as an effective therapy for heart failure: Evidence from a meta-analysis of 6,479 patients
(Lippincott Williams & Wilkins, 2025) J. Ruiz; Luis E. Cueva; Claudia Martinez‐Tapia; Carmen Chávez; Arianna Correa Siancas; Sergio Morales Acosta; Sol Juárez; Fátima Paico Bances; Adriana Robles; E Cubas
Background: Heart failure (HF) remains a leading cause of morbidity and mortality worldwide, with limited therapeutic options for improving long-term cardiovascular outcomes. Semaglutide, a GLP-1 agonist, has shown promising effects in improving cardiovascular function and metabolic control. However, its overall efficacy in patients with heart failure has not yet been established. Methods: We conducted searches of PubMed, Embase, Scopus, and Web of Science through February 21, 2025, identifying randomized controlled trials (RCTs) and cohort studies comparing semaglutide with placebo in patients with HF. The main outcomes were variation from baseline in 6-minute walk distance traveled (6MWD), C-reactive protein (CRP) concentration, amino-terminal prohormone brain natriuretic peptide (NT-proBNP) concentration, body weight, waist circumference, adjudicated HF event (hospitalization or urgent visit), cardiac mortality, all-cause mortality, serious adverse events (SAEs), and cardiac events. Relative risks (RR), mean differences (MD), and hazard ratios (HR) with their 95% confidence intervals (CI) were calculated using a random-effects model. Heterogeneity was assessed with the I 2 statistic. Results: Four RCTs and two cohort studies were included, with a total population of 6,479 patients with HF, of whom 3,200 (49.39%) received semaglutide and 3,279 (50.61%) received placebo. Treatment with semaglutide was associated with a significant increase in 6MWD (RR: 16.60; 95%CI: 10.58 to 22.62; p < 0.00001), a reduction in CRP (RR:0.59; 95%CI: 0.49 to 0.70; p<0.00001) and NT-proBNP (RR:0.81; 95%CI: 0.74 to 0.89; p<0.00001), a decrease in body weight (MD:-6.11; 95%CI: -11.41 to -0.82; p=0.02) and waist circumference (MD:-7.43; 95%CI: -9.26 to -5.60; p<0.00001). In addition, lower adjudicated HF events (RR:0.69; 95%CI: 0.50 to 0.97; p=0.03), SAEs (RR:0.77; 95%CI: 0.66 to 0.91; p=0.001), cardiac events (RR:0.54; 95%CI: 0.32 to 0.92; p=0.02), all-cause mortality (RR:0.80; 95%CI: 0.67 to 0.95; p=0.01) and cardiac mortality (HR:0.72; 95%CI: 0.60 to 0.86; p=0.0003). Conclusion: This meta-analysis is one of the first to approach the potential of semaglutide in patients with HF. Semaglutide significantly improves functional capacity and metabolic parameters while reducing cardiac events, SAEs, and mortality. These findings suggest that semaglutide may represent a promising therapeutic option in this population and further research is warranted to confirm these results.
Abstract 4355624: Reperfusion Strategies For Medium And Distal Vessel Occlusion: A Systematic Review And Network Meta-Analysis.
(Lippincott Williams & Wilkins, 2025) Amiel Aragon Cortes; Regla María Ledesma Santiago; Adolfo Calderón-Fernández; V. Beltran; Luis E. Cueva; Daniel Natera‐de Benito; Jose Gasca; Karoly Pamela Zuñiga Montaño; Óscar Martínez Pérez; A. A. De La Fuente
Evidence on the most effective treatment for stroke due to distal and medium vessel occlusions (DMVOs) remains unclear, as existing meta-analyses compare heterogeneous groups. We conducted a network meta-analysis to directly and indirectly compare different treatments for DMVOs: We performed a comprehensive search of databases through April 2025 to identify studies comparing endovascular treatment (EVT) with other therapies in DMVOs. We included 31 studies with EVT, intravenous thrombolysis (IVT), medical management (MM), and conservative management (CM) groups, including 7500 patients. Outcomes assessed included 90-day favorable modified Rankin Scale (mRS0–2), symptomatic intracranial hemorrhage (sICH), and 90-day mortality.: Compared to CM, EVT was associated with a higher rate of mRS 0–2 (RR:2.79, CI:95% 1.28–6.11, p = 0.01), while MM and IVT showed no significant differences. For mRS 3–6, CM (RR:3.05, CI:95% 1.43–6.55, p = 0.004) and thrombolysisIVT (RR:1.34, CI:95% 1.01–1.77, p = 0.04) carried greater risk than EVT. MM (RR: 0.59, CI:95% 0.35–1.00, p = 0.0498), IVT (RR:0.57, CI:95% 0.29–1.10, p = 0.10), and CM (RR:0.14, CI:95% 0.005–4.16, p = 0.26) showed non-significant lower sICH risk compared to EVT. No significant differences were found in 90-day mortality.: EVT consistently showed a favorable profile for mRS 0–2 at 90 days, with a non-significant increase in sICH and in 90-day mortality. These findings support EVT to improve functional recovery in DMVOs.
Abstract 4357666: Definitive Therapeutic Efficacy of Colchicine for Cardiovascular Disease A Systematic Review and Meta-Analysis in 37,812 Patients
(Lippincott Williams & Wilkins, 2025) Luis E. Cueva; Claudia Martinez‐Tapia; Ana Castro; Carlos Eduardo Espinosa Temaxte; Víctor Castillo; Karoly Pamela Zuñiga Montaño; José Gerardo González‐González; Adriana Campos; Abraham Zenteno-Aguilar; Sergio Morales Acosta
Background and Aims: Cardiovascular disease is a global health concern requiring effective prevention. Colchicine has gained interest for reducing cardiovascular events in high-risk patients. This study evaluates the efficacy and safety of colchicine in preventing these events. Methods: A systematic search was conducted in PubMed, CENTRAL, and Embase databases according to PRISMA guidelines, including studies up to August 26, 2024. Measures of effect included relative risk (RR) and mean differences. Meta-regressions and sensitivity analyses were performed to explore heterogeneity, which was quantified using the I 2 statistic. The certainty of evidence was assessed using the GRADE approach. Results: Analysis of 37,812 patients showed colchicine significantly reduced the risk of acute myocardial infarction (moderate certainty) (RR=0.81 [95% CI: 0.71-0.92], p=0.002), pericarditis (high certainty) (RR=0.48 [95% CI: 0.39-0.59], p<0.00001), atrial fibrillation (high certainty) (RR=0.74 [95% CI: 0.66-0.84], p<0.00001), acute coronary syndrome (high certainty) (RR=0.39 [95% CI: 0.23-0.65], p=0.0004) and hospitalization (high certainty) (RR=0.52 [95% CI: 0.38-0.70], p<0.0001). Outcomes such as cardiovascular mortality (moderate certainty), total mortality (moderate certainty), non-cardiovascular mortality (low certainty), length of hospital stay (low certainty), and cardiac tamponade (very low certainty) did not show statistically significant differences. Significant adverse effects included gastrointestinal disorders such as diarrhea, flatulence, nausea, and elevated ALT or AST levels. Conclusions: Colchicine effectively reduces cardiovascular event risk but may cause gastrointestinal side effects. Its benefit in cardiovascular prevention is clear, yet safety should be evaluated prudently.
Abstract 4360333: Pulmonary Vein Isolation Combined With Linear Ablation Improves Outcomes in Persistent Atrial Fibrillation: A Systematic Review and Meta-Analysis of 1,431 Patients
(Lippincott Williams & Wilkins, 2025) Luis E. Cueva; Juan Carlos Ruiz; Karoly Pamela Zuñiga Montaño; Sergio Morales Acosta; Diego Ramos Ypanaqué; José Hurtado; L. Urrego Rivera
Background: Persistent atrial fibrillation (AF) involves extensive atrial remodeling beyond pulmonary vein (PV) triggers, making catheter ablation less effective than in paroxysmal AF. PV isolation (PVI) is standard, but outcomes remain limited by broader arrhythmogenic substrates. Linear ablation aims to interrupt reentrant circuits and may improve outcomes when combined with PVI. However, its benefits remain debated due to procedural risks and incomplete lesions. Methods: We conducted a systematic review and meta-analysis (PRISMA guidelines), searching PubMed, Embase, Scopus, and Web of Science up to February 24, 2025. Eligible studies included randomized controlled trials (RCTs) and observational studies comparing PVI plus linear ablation versus PVI alone in adults with persistent AF. The primary outcome was AF recurrence; secondary outcomes were atrial arrhythmia recurrence and complications. Hazard ratios (HRs) and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed using the I 2 statistic. Significant heterogeneity was considered present if I 2 ≥ 50% and/or p < 0.10. Sensitivity was assessed using leave-one-out analysis, and heterogeneity was explored using subgroup analyses. Publication bias was also assessed using funnel plots. Results: Out of 113 articles, 4 were included (3 RCTs and 1 cohort study), with 1,431 patients: 696 (48.6%) underwent PVI plus linear ablation, and 735 (51.4%) underwent PVI alone. PVI plus linear ablation reduced AF recurrence (HR: 0.71; 95% CI: 0.54-0.91; p=0.009) and atrial arrhythmias (HR: 0.79; 95% CI: 0.64-0.98; p=0.03) compared to PVI alone. No significant difference in complications was found (RR: 0.43; 95% CI: 0.06-2.92; p=0.39). No significant heterogeneity or possible publication bias (symmetry in the funnel plots) was observed. Conclusion: This is the first meta-analysis exploring the addition of linear ablation to PVI in persistent AF. The findings suggest that this strategy reduces the risk of atrial arrhythmia recurrence without increasing complications, supporting its potential role in persistent AF ablation strategies. However, the limited number of studies and procedural variability highlight the need for further large-scale RCTs to confirm these results and guide patient selection. Clinicians should carefully consider individual patient characteristics and procedural factors when deciding on the best ablation approach.