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A recent systematic review and meta-analysis aimed to evaluate the comparative performance of intravascular imaging-guided PCI versus angiography-guided PCI, particularly with drug-eluting stents. This study was published in the journal Lancet by Prof. Gregg W Stone and colleagues.

The researchers conducted a comprehensive search of databases including MEDLINE, Embase, and Cochrane from inception to August 30, 2023, for randomized trials comparing intravascular imaging-guided PCI (intravascular ultrasound or OCT) with angiography-guided PCI. The primary endpoint was target lesion failure, including cardiac death, target vessel-myocardial infarction (TV-MI), or target lesion revascularization. Standard frequentist meta-analysis and network meta-analysis techniques were used to analyze direct and indirect data, respectively.

The key findings of the study were:

• Twenty-two trials involving 15,964 patients were included, with a mean follow-up duration of 24.7 months.

• Intravascular imaging-guided PCI demonstrated a decreased risk of target lesion failure compared to angiography-guided PCI (RR 0.71, 95% CI 0.63–0.80, p<0.0001).

• This reduction was driven by decreased risks of cardiac death (RR 0.55, 95% CI 0.41–0.75, p=0.0001), TV-MI (RR 0.82, 95% CI 0.68–0.98, p=0.030), and target lesion revascularization (RR 0.72, 95% CI 0.60–0.86, p=0.0002).

• Additionally, intravascular imaging guidance lowered the risks of stent thrombosis (RR 0.52, 95% CI 0.34–0.81, p=0.0036), all myocardial infarction (RR 0.83, 95% CI 0.71–0.99, p=0.033), and all-cause death (RR 0.75, 95% CI 0.60–0.93, p=0.0091).

• Similar outcomes were observed for OCT-guided and intravascular ultrasound-guided PCI.

Intravascular imaging guidance, whether using OCT or intravascular ultrasound, improves both safety and effectiveness of PCI compared to angiography guidance alone. This approach reduces risks of death, myocardial infarction, repeat revascularization, and stent thrombosis, enhancing patient outcomes in coronary stent implantation procedures.

Reference:

Stone, G. W., Christiansen, E. H., Ali, Z. A., Andreasen, L. N., Maehara, A., Ahmad, Y., Landmesser, U., & Holm, N. R. Intravascular imaging-guided coronary drug-eluting stent implantation: an updated network meta-analysis. Lancet,2024. https://doi.org/10.1016/s0140-6736(23)02454-6

“Mean nitrogen dioxide (NO2) and mean fine particulate matter (PM2.5) air pollution during the first three years of life were linked with asthma incidence by early and middle childhood, after adjusting for individual-level characteristics,” the researchers reported in their study published in JAMA Network Open.

The association of ambient pollution (NO2 or PM2.5) with incident asthma was modified by individual-level and community-level socioeconomic circumstances, including maternal education and race.

Air pollution is a near-ubiquitous exposure and contributes largely to disease and premature death in the world, including for children. Air pollution exposure has been consistently linked with respiratory morbidity, including exacerbation of asthma and wheezing in children. Various reviews on air pollution, asthma, and respiratory symptoms in children concluded that outdoor traffic pollution contributes to childhood asthma development. However, many studies lack the racial and ethnic, geographic, and socioeconomic diversity to evaluate susceptibility by individual-level and community-level contextual factors.

Against the above background, Antonella Zanobetti, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, and colleagues aimed to examine early life exposure to PM2.5 and NO2 air pollution and asthma risk by early and middle childhood. They also determined whether individual and community-level characteristics modify associations between air pollution exposure and asthma.

For this purpose, the researchers included children enrolled in cohorts participating in the Children’s Respiratory and Environmental Workgroup consortium. The location of the birth cohorts was throughout the US, recruited between 1987 and 2007, and followed up through 11 years.

The survival analysis was adjusted for parental asthma, mother’s education, child’s race and ethnicity, smoking during pregnancy, sex, neighbourhood characteristics, and cohort. Statistical analysis was performed from February 2022 to December 2023.

The study’s main outcomes were caregiver reports of physician-diagnosed asthma through early (age 4 years) and middle (age 11 years) childhood.

The study led to the following findings:

• Among 5279 included children, 51.5% were male; 24.7% of children had asthma by 11 years of age, and 18.1% had asthma by 4 years of age.
• Mean values of pollutants over the first 3 years of life were associated with asthma incidence.
• A 1 IQR increase in NO2 (6.1 μg/m3) was associated with increased asthma incidence among children younger than 5 years (HR, 1.25) and children younger than 11 years (HR, 1.22).
• A 1 IQR increase in PM2.5 (3.4 μg/m3) was associated with increased asthma incidence among children younger than 5 years (HR, 1.31) and children younger than 11 years (OR, 1.23).
• Associations of PM2.5 or NO2 with asthma were increased when mothers had less than a high school diploma, among Black children, in communities with fewer child opportunities, and in census tracts with a higher percentage of Black population and population density; for example, there was a significantly higher association between PM2.5 and asthma incidence by younger than 5 years of age in Black children (HR, 1.60) compared with White children (HR, 1.17).

“Air pollution continues to be a global burden with adverse consequences on childhood health,” the researchers wrote.

“Lowering asthma risk in the US requires reduction and regulation of air pollution combined with the creation of greater educational, environmental, and health equity at a community level,” they concluded.

Reference:

Zanobetti A, Ryan PH, Coull BA, et al. Early-Life Exposure to Air Pollution and Childhood Asthma Cumulative Incidence in the ECHO CREW Consortium. JAMA Netw Open. 2024;7(2):e240535. doi:10.1001/jamanetworkopen.2024.0535

The researchers found simple hysterectomy to be not inferior to radical hysterectomy concerning the 3-year incidence of pelvic recurrence in patients with low-risk cervical cancer. A simple hysterectomy was linked with a reduced risk of urinary incontinence or retention.

Retrospective data indicate that parametrial infiltration incidence is low in women with early-stage low-risk cervical cancer, which raises questions regarding the need for radical hysterectomy in these patients. However, there is a lack of data from large, randomized trials comparing outcomes of radical and simple hysterectomy.

To fill this knowledge gap, Marie Plante, the University of British Columbia, Vancouver, Canada, and colleagues conducted a multicenter, randomized, noninferiority trial comparing radical hysterectomy with simple hysterectomy including lymph-node assessment in patients with low-risk cervical cancer (lesions of ≤2 cm with limited stromal invasion).

The study’s primary outcome was cancer recurrence in the pelvic area (pelvic recurrence) at three years. The prespecified noninferiority margin for the between-group difference in pelvic recurrence at three years was 4 percentage points.

Based on the study, the researchers reported the following findings:

• Among 700 patients who underwent randomization (350 in each group), the majority had tumours that were stage IB1 according to the 2009 International Federation of Gynecology and Obstetrics (FIGO) criteria (91.7%), that had squamous-cell histologic features (61.7%), and that were grade 1 or 2 (59.3%).
• With a median follow-up time of 4.5 years, the incidence of pelvic recurrence at 3 years was 2.17% in the radical hysterectomy group and 2.52% in the simple hysterectomy group. Results were similar in a per-protocol analysis.
• The incidence of urinary incontinence was lower in the simple hysterectomy group than in the radical hysterectomy group within 4 weeks after surgery (2.4% vs. 5.5%) and beyond 4 weeks (4.7% vs. 11.0%).
• The incidence of urinary retention in the simple hysterectomy group was also lower than that in the radical hysterectomy group within 4 weeks after surgery (0.6% vs. 11.0%) and beyond 4 weeks (0.6% vs. 9.9%).

“In patients with low-risk cervical cancer, simple hysterectomy was not inferior to radical hysterectomy concerning the 3-year incidence of pelvic recurrence and was linked with a lower risk of urinary incontinence or retention,” the researchers wrote.

“The study findings challenge our current standards and provide evidence that in selected patients, simple hysterectomy appears to be safe, yielding oncologic outcomes similar to those of radical hysterectomy, but due to the specificity of the disease and patient factors certain points require additional analysis,” Pedro T. Ramirez, MD, chair of the department of obstetrics and gynaecology at Houston Methodist Hospital, wrote in an accompanying editorial.

He added, “It is critical to ensure that simple hysterectomy use is limited to patients having low-risk tumours and meeting the eligibility criteria for this conservative approach. Patients who do not meet such inclusion criteria should continue to be offered radical hysterectomy.”

Reference:

Plante M, Kwon JS, Ferguson S, Samouëlian V, Ferron G, Maulard A, de Kroon C, Van Driel W, Tidy J, Williamson K, Mahner S, Kommoss S, Goffin F, Tamussino K, Eyjólfsdóttir B, Kim JW, Gleeson N, Brotto L, Tu D, Shepherd LE; CX.5 SHAPE investigators; CX.5 SHAPE Investigators. Simple versus Radical Hysterectomy in Women with Low-Risk Cervical Cancer. N Engl J Med. 2024 Feb 29;390(9):819-829. doi: 10.1056/NEJMoa2308900. PMID: 38416430.