Search Results (218)

Background/Objectives: High-risk percutaneous coronary interventions (HR-PCIs) often require mechanical circulatory support (MCS) to maintain hemodynamic stability. Intra-aortic balloon pump (IABP) and percutaneous left ventricular assist device (PLVAD) are two commonly used MCS devices that differ in their mechanisms. We aimed to evaluate and compare the clinical outcomes associated with IABP and PLVAD use in HR-PCIs without cardiogenic shock. Methods: We conducted a search of PubMed, Scopus, Cochrane, Mendeley, Web of Science, and Embase to identify relevant randomized controlled trials and cohort studies, and we included 13 studies for the systematic review and meta-analysis. The primary goal was to define the difference in early mortality (in-hospital and 30-day mortality), major bleeding, and major adverse cardiovascular event (MACE) components (cardiogenic shock, acute kidney injury (AKI), and stroke/TIA) in IABP and PLVAD. We used a random-effects model with the Mantel–Haenszel statistical method to estimate odds ratios (ORs) and 95% confidence intervals. Results: Among 1 trial and 12 cohort studies (35,554 patients; 30,351 IABP and 5203 PLVAD), HR-PCI with IABP was associated with a higher risk of early mortality (OR = 1.53, 95% CI [1.21, 1.94]) and cardiogenic shock (OR = 2.56, 95% CI [1.98, 3.33]) when compared to PLVAD. No significant differences were found in the rates of arrhythmia, major bleeding, AKI, stroke/TIA, or hospital length of stay. Conclusions: In high-risk PCIs, PLVAD use is associated with lower early mortality and cardiogenic shock risk compared to IABP, with no significant differences in other major outcomes. Full article

Background: Intracerebral hemorrhage (ICH) is a severe form of stroke associated with high morbidity and mortality. While neurosurgical evacuation may offer theoretical benefits, its impact on survival and hospital course remains debated. We aimed to compare the outcomes of surgical versus conservative management in patients with lobar, capsulo-lenticular, and thalamic ICH and to identify factors influencing mortality and the surgical decision. Methods: This single-center, retrospective cohort study included adult patients admitted to the County Clinical Emergency Hospital of Sibiu (2017–2023) with spontaneous supratentorial ICH confirmed via CT (deepest affected structure determining lobar, capsulo-lenticular, or thalamic location). We collected data on demographics, clinical presentation (Glasgow Coma Scale [GCS], anticoagulant use), hematoma characteristics (volume, extension), treatment modality (surgical vs. conservative), and in-hospital outcomes (mortality, length of stay). Statistical analyses included t-tests, χ², correlation tests, and logistic regression to identify independent predictors of mortality and surgery. Results: A total of 445 patients were analyzed: 144 lobar, 150 capsulo-lenticular, and 151 thalamic. Surgical intervention was more common in patients with larger volumes and lower GCS. Overall, in-hospital mortality varied by location, reaching 13% in the lobar group, 20.7% in the capsulo-lenticular group, and 35.1% in the thalamic group. Within each location, surgical intervention did not significantly reduce overall in-hospital mortality despite the more severe baseline presentation in surgical patients. In lobar ICH specifically, no clear survival advantage emerged, although surgery may still benefit those most severely compromised. For capsulo-lenticular hematomas > 30 mL, surgery was associated with lower mortality (39.4% vs. 61.5%). In patients with large lobar ICH, surgical intervention was associated with mortality rates similar to those seen in less severe, conservatively managed cohorts. Multivariable adjustment confirmed GCS and hematoma volume as independent mortality predictors; age and volume predicted the likelihood of surgical intervention. Conclusions: Despite targeting more severe cases, neurosurgical evacuation did not uniformly lower in-hospital mortality. In lobar ICH, surgical patients with larger hematomas (~48 mL) and lower GCS (~11.6) had mortality rates (~13%) comparable to less severe, conservative cohorts, indicating that surgical intervention was associated with similar mortality rates despite higher baseline risk. However, these findings do not establish a causal survival benefit and should be interpreted in the context of non-randomized patient selection. For capsulo-lenticular hematomas > 30 mL, surgery was associated with lower observed mortality (39.4% vs. 61.5%). Thalamic ICH remained most lethal, highlighting the difficulty of deep-brain bleeds and frequent ventricular extension. Across locations, hematoma volume and GCS were the primary outcome predictors, indicating the need for timely intervention, better patient selection, and possibly minimally invasive approaches. Future prospective multicenter research is necessary to refine surgical indications and validate these findings. To our knowledge, this investigation represents the largest and most contemporary single-center cohort study of supratentorial intracerebral hemorrhage conducted in Romania. Full article

Background and Objectives: Ischemic stroke (IS) is a critical health issue, affecting individuals of all ages, sexes, and backgrounds. Mounting evidence suggests that sex indeed could play some distinct role in shaping the incidence, outcomes, and treatment of IS. In the context of the COVID-19 pandemic, contradictory findings from previous studies that also addressed sex differences in cerebrovascular diseases demonstrate the need for further focused research. This study aimed to evaluate the sex discrepancies in the clinical presentation of IS and its outcomes in patients admitted to Kaunas Hospital of the Lithuanian University of Health Sciences (LUHS), Lithuania. Materials and Methods: This is a retrospective record-based single-center study. All the study patients—727 men and 1082 women—enrolled between 1 January 2020, and 27 February 2022; suffered from acute IS; and had absolute contraindications against interventional IS treatment. These patients received a conservative non-interventional IS treatment at the neurological department of the LUHS’s Kaunas Hospital. The sociodemographic data; laboratory findings; comorbidities, including COVID-19; in-hospital complications; and outcome factors were obtained from the patients’ medical records and evaluated by deploying appropriate statistical tests. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by the Cox proportional hazards regression for in-hospital lethality. Results: The mean age of IS patients was significantly higher in women compared to men (p < 0.001), as was the proportion of in-hospital deaths (19.10% and 15.36%, respectively; p < 0.05). The mean total number of in-hospital complications was again significantly higher in the group of women compared to men (p < 0.05). The prevalence of COVID-19 was higher in men compared to women (p < 0.05). COVID-19 diagnosis (HR = 1.53; p = 0.02) and acute in-hospital pulmonary complications (HR = 1.91; p = 0.008) significantly increased the risk of in-hospital lethality in men. The risk of in-hospital lethality was significantly higher in women with comorbid diabetes mellitus type 2 (DM) compared to those with comorbid isolated arterial hypertension (AH) (HR = 2.25, p = 0.007). Increased C-reactive protein elevated the risk of in-hospital lethality by more than twice in both men and women (HR = 2.46; p < 0.001 and HR = 2.28; p < 0.001, respectively). Conclusions: The following differences between men and women with IS were determined: Acute in-hospital pulmonary complications, including COVID-19, significantly increased the risk of in-hospital lethality in the male group, but not in women. However, women suffering from DM had a significantly increased risk of in-hospital lethality compared with those women IS patients with AH or chronic ischemic heart disease (IHD). Increased C-reactive protein was associated with an elevated risk of in-hospital lethality both in male and female groups. Full article

Objectives: To assess the long-term survival outcomes of patients undergoing no-touch aorta, total arterial off-pump coronary artery bypass grafting (OPCAB) using a left internal mammary artery (LIMA)–radial artery (RA) Y-graft configuration. This approach was applied uniformly to all-comers undergoing isolated CABG between 2004 and 2021, irrespective of preoperative risk profile. Methods: We included all patients treated with total arterial OPCAB using the LIMA–RA Y-graft without additional concomitant procedures. Patients were stratified into five age groups (<50, 50–59, 60–69, 70–79, and >80 years). Survival at 5 years was analyzed using Kaplan–Meier curves and Cox regression analysis. Results: A total of 2174 patients were analyzed, with a median follow-up of 3266 days. In-hospital mortality was 0.6%, whereas postoperative stroke was 0.3% without residual trauma and 0.2% with residual trauma, respectively, without differences between age groups. The mean number of grafts per patient was 3.7, with no significant variation between age groups (p = 0.09). Overall, 5-year survival was 90% (n = 1767), ranging from 98% in the youngest group to 65% in the oldest (log-rank p < 0.0001). Conclusions: No-touch aorta, total arterial OPCAB using the LIMA–RA Y-graft is a safe and effective revascularization strategy for a broad spectrum of patients, including those with advanced age and comorbidities. Full article

Background/Objectives: Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) is a key approach for treating degenerated surgical bioprosthetic valves. The ACURATE neo2 valve, with its advanced sealing technology and optimized coronary access, represents a promising solution for the challenges of ViV TAVI. This study evaluates the procedural and 30-day and 1-year follow-up outcomes of the ACURATE neo2 valve in ViV TAVI. Methods: This single-center, single-operator prospective study included patients with symptomatic bioprosthetic valve dysfunction, classified in New York Heart Association (NYHA) class III or IV, who underwent ViV TAVI with ACURATE neo2 at our center between July 2022 and February 2024. Outcomes were assessed using VARC-3 criteria. Results: Fifty-five patients (51% females, median (IQR) age 76 (8) years) were included. The technical success rate was 98.2%. No patients experienced in-hospital mortality, stroke, MI, bleeding, vascular complications, renal failure, or new pacemaker implantation. Three patients (5.5%) underwent elective chimney stenting for coronary protection. The postprocedural mean aortic gradient was 6.7 ± 1 mmHg, with a mean aortic valve area (AVA) of 2.0 ± 0.1 cm². Over a median follow-up period of 1.2 years, no deaths (0%) were observed, heart failure hospitalization rate was 3.6%, and NYHA class improved to ≤II in 100% of patients. Conclusions: ACURATE neo2 demonstrated excellent technical success, sustained hemodynamic performance, and significant clinical improvement in ViV TAVI. The absence of major adverse events reinforces its safety, efficacy, and durability as a treatment for degenerated surgical bioprostheses. Full article

Background/Objectives: The ankle-brachial index (ABI) is a non-invasive diagnostic tool for peripheral artery disease (PAD) and a marker of systemic atherosclerosis, predictive of cardiovascular (CV) events. The ambulatory arterial stiffness index (AASI), derived from 24-h blood pressure monitoring, also predicts CV morbidity and mortality, particularly stroke. However, their combined prognostic utility in acute myocardial infarction (AMI) remains underexplored. This study aimed to assess the predictive value of ABI and AASI in patients with AMI. Methods: We conducted a single-center observational cohort study including 441 consecutive patients with AMI (79% male; mean age 62 years). ABI was measured using an automated device, with ≤0.9 defined as abnormal. AASI was calculated from 24-h blood pressure recordings. The primary endpoint was a composite of all-cause and CV death and major CV events, assessed in-hospital and over a 3-year follow-up. Results: Median ABI was 1.10 (IQR 1.00–1.18); 10.4% had abnormal ABI. Abnormal ABI was associated with a threefold higher risk of in-hospital adverse events (OR 2.93, 95% CI: 1.48–5.81, p = 0.002). In Cox regression, abnormal ABI predicted long-term all-cause mortality (HR 2.88, 95% CI: 1.53–5.42, p = 0.001), independent of traditional risk factors. Each 0.1 increase in AASI was linked to a 21% higher risk of the composite outcome (p = 0.001) and 25% increased risk of recurrent AMI or urgent revascularization (p = 0.001). Conclusions: In this prospective cohort of patients with AMI, ABI and AASI were associated with adverse outcomes, suggesting their potential role in risk stratification. These exploratory findings require validation in larger, multicenter cohorts to assess their incremental prognostic value and generalizability. Full article

Background: The burden of stroke is on the rise in low-income countries (LICs). Organized stroke care (OSC) is crucial for improving outcomes in LICs and is the very first step to reducing delays in diagnosis and treatment. We aim to evaluate delay times (DT) in accessing OSC at the national reference hospital of Mozambique, a LIC from southern Africa. Methods: An observational study based on consecutive case series of 59 stroke patients confirmed by computed tomography (CT) scans over a period of 3 months (May–July 2023). The total DT (from stroke onset to inward hospitalization) was the main outcome. Other specific DTs were analyzed including initial symptoms to arrival and admission (DT0), arrival to CT scans (DT1), arrival of laboratory results (DT2), and arrival to inward hospitalization (DT3). Results: The mean age was 61.9 (min 30–max 90) and 45.8% were female. The median total DT was 20 h. The median time DT0 was 10.6 h (interquartile range (IQR): 16.48). The median DT1 and DT2 were 4 h (IQR: 3.5) and 5 h (IQR: 2.6), respectively. The median DT3 was 10 h (IQR: 4). None of the patients were treated under a stroke code. Conclusions: This study reveals an unacceptable prehospital and in-hospital DT. Waiting for the CT scan contributed to a large proportion of the total DT, which among other factors can be explained by the absence of a stroke code and limited imaging capacity. These findings mirror disparities in stroke care seen in other LICs, where late presentation, scarce imaging, and limited specialized protocols are common. The urgent implementation of organized prehospital and in-hospital stroke pathways is needed in Maputo to improve outcomes. Full article

Background: Acute heart failure (AHF) is a major cause of hospitalizations, posing significant challenges to healthcare systems. Despite advancements in management, the rate of poor outcomes remains high globally, emphasizing the need for timely interventions. This study aimed to identify early admission-based factors predictive of poor outcomes in hospitalized AHF patients, in order to contribute to early risk stratification and optimize patient care. Methods: This retrospective single-center study analyzed routine data of adult patients hospitalized for AHF at a public university teaching hospital in Switzerland. Outcomes included in-hospital death, intensive care (ICU) treatment, and length of hospital stay (LOHS). Potential predictors were limited to routine parameters, readily available at admission. Missing predictor data was imputed and predictors were identified by means of multivariable regression analysis. Results: Data of 638 patients (median age 84 years, range 45–101 years, 50% female) were included in the study. In-hospital mortality was 7.1%, ICU admission rate 3.8%, and median LOHS was 8 days (IQR 5–12). Systolic blood pressure ≤ 100 mmHg (Odds ratio (OR) 3.8, p = 0.009), peripheral oxygen saturation ≤ 90% or oxygen supplementation (OR 5.9, p < 0.001), and peripheral edema (OR 2.7, p = 0.044) at hospital admission were identified as predictors of in-hospital death. Furthermore, a stroke or transient ischemic attack in the patient’s history (OR 3.2, p = 0.023) was associated with in-hospital death. ICU admission was associated with oxygen saturation ≤ 90% or oxygen supplementation (OR 22.9, p < 0.001). Factors linked to longer LOHS included oxygen saturation ≤ 90% or oxygen supplementation (IRR 1.2, p < 0.001), recent weight gain (IRR 1.1, p = 0.028), and concomitant chronic kidney disease (IRR 1.2, p < 0.001). Conclusions: This study validated established predictors of AHF outcomes in a Swiss cohort, highlighting the predictive value of poor perfusion status, fluid overload, and comorbidities such as chronic kidney disease. The identified predictors imply potential for developing tools to improve rapid treatment decisions. Future research should focus on the prospective external validation of the identified predictors and the design and validation of risk scores, incorporating these parameters to optimize early interventions and reduce adverse outcomes in AHF. Full article

Background: Myocarditis is a life-threatening condition with an increasing incidence in the past two decades. Little is known about the frequency of specific causes of death following myocarditis. This study aimed to identify the different causes of death after myocarditis diagnosis and determine factors associated with mortality. Methods: We conducted a retrospective population-wide observational study in New South Wales (NSW), Australia from July 2004 to September 2021. Data were attained from the NSW Admitted Patient Data Collection database and death was tracked from the death registry to 31 March 2022. Cause of death was ascertained from manual reviews of all death certificates and adjudicated independently by three reviewers. Results: Among 4071 unique index admissions for myocarditis (median age: 42 years; 66% male), cumulative all-cause mortality was 4.5% in-hospital, 8.2% at 1 year, 13.3% at 5 years and 15.5% by the end of follow up (median 5.3 years). Within 30 days of admission, the leading cause of death was cardiovascular (66%), including myocarditis (36%) and heart failure (12%). Non cardiovascular causes accounted for 32% of deaths and included infection (17%) and malignancy (6%). Beyond 30 days, cardiovascular deaths declined to 34% (only 3% due to myocarditis). Higher mortality risk was associated with older age, higher Charlson comorbidity index, and myocarditis complicated by intensive care unit admission, heart failure, stroke, or arrhythmia. Conclusions: Patients admitted with myocarditis face significant mortality risks. The highest mortality occurs within the first 30 days, predominantly due to cardiovascular causes, although after 30 days the predominant cause of death shifts to non-cardiovascular causes. Full article

Background: Both distance to the hospital and hospital reputation influence patient choice of hospital; but the combined effect of these factors and how they relate to hospitalization outcomes has yet to be determined. The purpose of this study was to assess the combined influence of distance to hospital and hospital reputation on the hospitalization outcomes in patients with stroke. Methods: This retrospective observational study utilized data from 69,107 stroke patients hospitalized in southern Chinese megacity between 2019 and 2021. A generalized linear model was used to assess the association between hospital reputation, distance to the hospital, hospitalization costs, and the length of stay. Multivariate logistic regression was used to estimate the combined effect on in-hospital mortality. Results: Compared with patients who chose hospitals without a good reputation and close to home, those who chose hospitals with a good reputation had lower hospitalization costs (−0.05; 95% CI: −0.08 to −0.02), a shorter length of stay (−0.18; 95% CI: −0.20 to −0.16), and lower in-hospital mortality (0.52; 95% CI: 0.40 to 0.67). However, patients who chose hospitals with a good reputation but farther distance experienced higher hospitalization costs (0.20; 95% CI: 0.17 to 0.23). Conclusions: A shorter distance to the hospital and a higher reputation of the hospital are associated with lower costs and better outcomes. Our study indicates that improving outcomes for patients with stroke requires equitable distribution of quality medical resources. Full article

Aims: This study aimed to evaluate whether the pan-immune inflammation value (PIV) has prognostic value for major adverse cardiac events (MACEs), including stroke, rehospitalization, and in-hospital and one-year all-cause mortality, in patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). Methods: A total of 152 patients undergoing TAVI were retrospectively analyzed and stratified into two groups based on a PIV cutoff value of 488. Baseline clinical, laboratory, echocardiographic, and procedural characteristics were compared. Clinical outcomes, including mortality, cerebrovascular events, and bleeding complications, were assessed. Multivariable logistic regression and receiver operating characteristic (ROC) curve analyses were performed to identify independent mortality predictors and evaluate the predictive performance of PIV. Results: Among the 152 patients (mean age 77 ± 7 years; 59.9% female), 52 (34.2%) had a PIV ≥ 488. These patients had significantly higher rates of diabetes mellitus (62% vs. 38%, p = 0.006), chronic kidney disease (31% vs. 12%, p = 0.005), and chronic obstructive lung disease (31% vs. 15%, p = 0.022), along with higher STS scores (16.3 vs. 11.7, p = 0.003). Inflammatory markers were elevated, and lymphocyte and hemoglobin levels were reduced in the high PIV group (p < 0.001). Patients with PIV ≥ 488 experienced significantly higher one-year mortality (58% vs. 4%, p < 0.001), in-hospital mortality (21% vs. 2%, p < 0.001), rehospitalization (29% vs. 4%, p < 0.001), ischemic cerebrovascular events (12% vs. 4%, p < 0.001), and major bleeding (10% vs. 2%, p = 0.034). Multivariable analysis identified age (OR: 1.108; 95% CI: 1.010–1.217; p = 0.031) and PIV (OR: 1.006; 95% CI: 1.003–1.008; p < 0.001) as independent mortality predictors. The PIV showed a strong predictive performance (AUC: 0.90, p < 0.001), with 88% sensitivity and 81% specificity. Kaplan–Meier analysis showed significantly lower survival in the high PIV group (p < 0.001). Conclusions: A high preprocedural PIV is an independent predictor of MACEs, in-hospital, and one-year mortality in AS patients undergoing TAVI. Full article

Background/Objectives: Contrast-induced nephropathy (CIN) is a well-documented complication following coronary angiography and percutaneous coronary intervention (PCI). This study aims to evaluate the predictors of CIN and its effect on outcomes in patients with acute coronary syndrome (ACS). Methods: A retrospective study included 1579 patients who underwent coronary angiography or PCI. Results: The overall incidence of in-hospital CIN was 6.8%, with the highest incidence in the group with eGFR <30 mL/min/1.73 m² at 21.6%. Non-radial vascular access was an independent predictor of CIN occurrence (OR = 2.06 [1.37–3.08]; p < 0.001). The risk of death within 30 days was influenced by history of stroke (OR = 4.94 [1.58–15.51]; p = 0.006), glucose level on admission (per 10-unit increase) (OR = 1.07 [1.04–1.1]; p < 0.001), occurrence of CIN (OR = 5.64 [2.49–12.79]; p < 0.001), and hemoglobin level (OR = 0.77 [0.65–0.92]; p = 0.003). The risk of death within 365 days was increased by age (OR = 1.05 [1.02–1.07]; p < 0.001), history of stroke (OR = 2.45 [1.02–5.89]; p = 0.046), glucose levels on admission (per 10-unit increase) (OR = 1.05 [1.03–1.08]; p < 0.001), occurrence of CIN (OR = 2.62 [1.42–4.84]; p = 0.002), and hemoglobin concentration (OR = 0.78 [0.7–0.88]; p = 0.003). An independent predictor of hospitalization for acute or exacerbation of chronic renal failure was baseline creatinine concentration (OR = 3.44 [2.4–4.93]; p < 0.001). Conclusions: The incidence of CIN is significant, particularly in patients with severe pre-existing renal impairment. Non-radial vascular access is an independent predictor of CIN. The occurrence of CIN is a strong independent predictor of both short-term and long-term mortality. Full article

Background: This study examines the impact of Body Mass Index (BMI) on outcomes after mitral valve surgery via right minithoracotomy, an approach that may reduce wound complications in obese patients. Methods: Between January 2010 and December 2024, 1773 adult patients underwent minimally invasive mitral valve surgery at our institution. They were categorized into three groups: normal weight (BMI < 25, n = 942), overweight (BMI 25–30, n = 661), and obese (BMI > 30, n = 170). Results: The three groups exhibited significant differences, with a higher prevalence of hypertension, dyslipidemia, and diabetes (p < 0.001) in overweight and obese patients. Further-more, they had a greater incidence of preoperative atrial fibrillation (p < 0.001), prior stroke (p = 0.023), chronic obstructive pulmonary disease (p = 0.002), and elevated preoperative creatinine levels (p < 0.001). and their euroscore II was significantly higher (p = 0.040). In-hospital mortality and major complications were similar across groups, except for drainage output in the first 24 h (p = 0.002) and ICU stay (p = 0.022), both resulting higher in the overweight and obese patients. We employed inverse probability of treatment weighting (IPTW) to create three well-matched groups. Following IPTW, postoperative outcomes remained comparable across groups. However, obese patients exhibited a higher incidence of postoperative atrial fibrillation (p = 0.037) and required pacemaker implantation more frequently (p < 0.001). Conclusions: Our findings suggest that obesity does not increase the risk of mortality or major adverse events after minimally in-vasive mitral valve surgery. This approach may offer a less invasive alternative for obese patients, potentially reducing the risk of wound complications associated with conventional surgery. Full article

Background: Heart failure (HF), chronic kidney disease (CKD), and atrial fibrillation (AF) frequently coexist, forming a high-risk triad that amplifies morbidity and mortality through shared pathophysiological mechanisms such as neurohormonal activation, fluid overload, and inflammation. Current risk stratification tools, including CHA₂DS₂-VASc and HAS-BLED, inadequately capture the complexity of these multimorbid patients. This study aims to explore the influence of comorbidities, hypertension severity, anticoagulation strategy, and risk scores on hospitalization outcomes in patients with coexisting HF, CKD, and AF. Materials and Methods: A retrospective case study was conducted on 174 hospitalized patients with HF, CKD, and AF. Clinical data included hypertension grade, HF phenotype (HFpEF vs. HFrEF), NYHA classification, renal function (KDIGO stage), stroke and bleeding risk scores (CHA₂DS₂-VASc: congestive heart failure, hypertension, age ≥ 75, diabetes, and stroke/TIA; HAS-BLED: hypertension, abnormal renal/liver function, stroke, bleeding, labile INR, elderly, and drugs/alcohol), comorbidities (neurological, psychiatric, COPD, and diabetes), anticoagulation type (DOACs vs. VKAs), and length of hospital stay. Statistical analysis included Spearman correlation, independent t-tests, and multivariate regression to evaluate associations between variables and clinical outcomes. Results: Most patients were elderly (mean age 75 ± 12), with advanced CKD (stage 3b) and systolic HF (77% HFrEF). Mean CHA₂DS₂-VASc was 5.67, HAS-BLED was 4.40, and ATRIA was 4.74, indicating high stroke and bleeding risk. Anticoagulation was predominantly via DOACs (69.5%). Hypertension severity did not significantly correlate with NYHA class (ρ = −0.14, p = 0.068). Neurological, psychiatric, and metabolic comorbidities showed no significant associations with HF severity. COPD and diabetes correlated inversely with CHA₂DS₂-VASc scores (ρ = −0.83, p = 0.014). No significant differences were observed in hospital stay between HF phenotypes or prior stroke history. In-hospital mortality was low (2.3%). Conclusions: Traditional risk scores do not fully capture the complexity of multimorbid patients. Metabolic comorbidities showed an inverse correlation with stroke risk scores, and no significant correlation was observed between hypertension severity and HF symptom burden. Hypertension and common comorbidities did not correlate with HF symptom burden, and metabolic diseases may paradoxically associate with lower stroke risk scores. These findings highlight the need for improved multimodal risk assessment strategies that consider the heterogeneity of multimorbid populations. Personalized, integrated approaches are essential to optimize anticoagulation, reduce hospitalization, and improve prognosis. Full article

Background/Objectives: Patients with atrial fibrillation and mitral regurgitation (MR) undergoing transcatheter edge-to-edge mitral valve repair (M-TEER) often have concomitant indications for left atrial appendage occlusion (LAAO), mandating a more personalized treatment approach. This study aimed to examine the effectiveness and safety of combining M-TEER/LAAO in one procedure. Methods: MEDLINE (PubMed), Scopus, and Cochrane were searched through 21 March 2025 for studies examining M-TEER/LAAO with or without control (M-TEER only). Double-independent study selection, extraction, and quality assessments were performed. Frequentist random-effects models were used to calculate mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs). Results: Seven studies (223 participants) were included. For M-TEER/LAAO, the mean procedural time was 101.6 min (95% CI = [85.06, 118.13]), the mean radiation time was 29.97 min (95% CI = [23.85, 36.09]), the mean length of stay was 5.21 days (95% CI = [3.31, 7.12]), procedural success was achieved in 89.5% of cases (95% CI = [73.4, 96.3], and post-procedure MR > 2+ occurred in 14.8% of cases (95% CI = [3.6, 44.5]). Compared to M-TEER only, patients with M-TEER/LAAO had similar procedural (RR = 0.91, 95% CI = [0.71, 1.17]) and technical success (RR = 1, 95% CI = [0.94, 1.06]) with a similar risk of acute kidney injury (RR = 1, 95% CI = [0.07, 15.12]), bleeding (RR = 0.40, 95% CI = [0.01, 18.06]), and all-cause death (RR = 0.59, 95% CI = [0.22, 1.54]). M-TEER/LAAO was non-significantly associated with in-hospital death (RR = 3, 95% CI = [0.13, 70.23]), stroke (RR = 3, 95% CI = [0.13, 70.23]), and vascular complications (RR = 1.55, 95% CI = [0.43, 5.59]) compared to M-TEER only. Most patients (34.2%, 95% CI = [2.8, 90.4]) received dual antiplatelet therapy at discharge, followed by anticoagulation only (20.2%, 95% CI = [7.5, 44.3]). Conclusions: M-TEER/LAAO can be combined into a single procedure with good peri-procedural outcomes. Safety was also satisfactory; however, some concerns may arise regarding in-hospital death, stroke, and vascular complications. Further research is needed to explore the effectiveness and safety of this combined strategy and elucidate the risk–benefit profile of this personalized treatment approach. Full article