Suchday, Pooja

BACKGROUND: Studies in the past have demonstrated an association between sarcoidosis and pulmonary embolism but little is known about its impact, especially in young adults. We aim to determine the burden and impact of pulmonary embolism (PE) in young adults hospitalized with sarcoidosis. METHOD: The study investigates the prevalence and consequences of PE in young adults aged 18-44 years hospitalized with sarcoidosis using data from the National Inpatient Sample (2016-2020) with relevant ICD-10 codes. This study aims to address the primary outcomes of the burden and trends of PE and its associated impact on in-hospital mortality. Additionally, it explores secondary outcomes such as healthcare resource utilization and discharge patterns. RESULT: Among 50,385 young adults (median age 37 years) hospitalized with sarcoidosis, 1120 had PE, showing a linear increase from 2% in 2016 to 2.9% (p<0.001) in 2020. Sarcoidosis-PE+ group, predominantly in young blacks, exhibited a higher prevalence of comorbidities such as obesity, smoking, drug use, peripheral vascular disease, hypothyroidism, and prior history of VTE. In contrast, the sarcoidosis-PE- group had a higher prevalence of diabetes (with/without chronic complication), hyperlipidemia, and chronic pulmonary disease. Multivariable regression analysis adjusted for all potential sociodemographic and comorbid variables showed higher odds of all-cause mortality (OR: 2.92, 95% CI: 1.18-7.24, p <0.02) in the sarcoidosis-PE+ group as compared to sarcoidosis-PE- group. The sarcoidosis-PE+ group also had higher hospital costs and length of stay. CONCLUSION: The higher odds of in-hospital mortality with an increased length of stay and hospital cost observed in the sarcoidosis-PE+ group highlight the often underreported complications of sarcoidosis, particularly in a younger demographic. The relevance of this study stems from its potential to uncover trends that could lead to improved diagnostic and therapeutic strategies.

Introduction: Lipoprotein (a) [Lp(a)] has been recognized as an independent predictor of atherosclerotic cardiovascular disease (ASCVD). However, there is limited data on the association between Lp(a) levels and risk of recurrent myocardial infarction (MI)/coronary revascularization in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI). Methods: PubMed/Medline, EMBASE, and Scopus were searched for studies evaluating the association of Lp(a) with recurrent ischemic events from the year 2000-2023. Patients with coronary artery disease or ACS with baseline Lp(a) who underwent PCI or coronary stenting and had outcomes as recurrent MI/ coronary revascularization were included. Random effects models and I 2 statistics were used for pooled hazard ratios (HR), odds ratio (OR), and heterogeneity assessment. A leave-one-out sensitivity analysis was also performed. Results: The initial search resulted in 651 articles, of which nine studies with 27964 patients (mean age 58-66 years, 74.79% male) were included. Of the nine studies, six were retrospective and three prospective. Mean±SD/Median (IQ) follow-up duration was four years [range 2-7 years]. There was an increased risk of recurrent MI/coronary revascularization associated with Lp(a) ≥30 mg/dL (OR, 1.44, 95% CI: 1.09-1.89, I 2 = 79.24%, p=0.009) (Fig 1a) and Lp(a) ≥10-30 mg/dL (OR, 1.19, 95% CI: 1.009-1.416, I 2 = 0%, p=0.039) (Fig 1b), but failed to reach significance with Lp(a) as a continuous variable (OR, 1.004, 95% CI: 0.998-1.009, I 2 = 85.02%, p=0.221) (Fig 1c). Leave-one-out sensitivity analysis showed an equivalent result for various Lp(a) cutoffs (Fig 1a, 1b, and 1c). Conclusions: Our meta-analysis suggests an association of raised Lp(a) with increased risk of recurrent MI/coronary revascularization in ACS patients who underwent PCI.