Panjwani, Shaliza

Introduction: As the global elderly population grows, so does the incidence of acute coronary syndrome (ACS) requiring urgent intervention. Emergency coronary artery bypass grafting (CABG) may offer a survival benefit, but concerns remain about its feasibility and safety in critically ill elderly patients with multiple comorbidities. Description of Case: This single-surgeon case series includes eight patients >65 years old who underwent emergency CABG for ACS between September 2023 and September 2024. Comorbidities included diabetes, hypertension, CKD, COPD, and previous stroke. All patients were critically ill, requiring combinations of inotropes, intra-aortic balloon pump (IABP), and mechanical ventilation. Ejection fractions ranged from 20–45%, and EuroSCOREs ranged from 10.86 to 30.45. Standard cardiopulmonary bypass with moderate hypothermia and a single aortic cross-clamp was used. Postoperatively, complications included transient ischemic attacks, dialysis-requiring renal dysfunction, atrial fibrillation, and infections. All patients survived; extubation times ranged from 7 to 70 hours, and hospital stays from 5 to 12 days. Discussion: This case series examines outcomes of CABG in elderly patients, emphasizing that despite multiple comorbidities, through physiological assessment, CABG can safely be performed in critically ill patients Although the LVEF was low and multiple comorbidities like diabetes and chronic kidney disease, signify the importance of a comprehensive assessment of physiology beyond standard biomarkers is necessary to determine readiness for surgery. Ventilation times variations highlighted the consequences of pulmonary and hematological challenges encountered in these patients. Recent advances in surgical techniques and perioperative care have improved outcomes, and most patients showed enhanced quality of life and physical function within a year post-surgery. Conclusion: Emergency CABG can be a lifesaving therapy in critically ill elderly ACS patients. With careful perioperative management, advanced age and comorbidity burden should not preclude surgical intervention.

e13162 Background: BRCA1/2 mutations impair homologous recombination repair, forcing cancer cells to rely on alternative DNA repair pathways, such as those mediated by poly(ADP-ribose) polymerase (PARP). PARP inhibitors (PARPis), like iniparib, olaparib, talazoparib, niraparib, and veliparib, exploit this dependency, inducing lethality in cells of BRCA-mutated, HER2-negative breast cancers (BRCAm, HER2-BC). Only 2 PARPis, talazoparib and olaparib, are FDA-approved for BRCAm, HER2-BC. However, the treatment with the highest efficacy remains unclear. We conducted a network meta-analysis (NMA) of randomised controlled trials (RCTs) to compare the efficacy of PARPis in treating BRCAm, HER2-BC. Methods: We systematically searched PubMed, Cochrane CENTRAL, SCOPUS, and ClinicalTrials.gov (up to December 2024) for randomized controlled trials (RCTs) following PRISMA-NMA guidelines. Primary outcome was overall survival(OS), with hazard ratios (HRs) and 95% confidence intervals (CIs). Secondary outcome was progression-free survival (PFS). Survival times were converted to HRs under the assumption of exponential distribution. Standard of care (SOC) was defined as taxane/anthracycline-based regimens with additional platinum-based chemotherapy. Physician's choice chemotherapy (PCT) included capecitabine, eribulin, gemcitabine, or vinorelbine. A frequentist approach with random-effects modeling was used to pool estimates, and P-scores ranked treatment efficacy. Heterogeneity and inconsistency were assessed using τ², I², and Q-statistics. Analyses were conducted in R version 4.4.1. Results: 8 studies including 4432 participants incorporating 8 pairwise comparisons and 7 treatments were analyzed for OS. Compared to SOC (reference), HRs of OS were significantly reduced with talazoparib+SOC (HR = 0.49, 95% CI: 0.32–0.74; P = 0.64), olaparib+SOC (HR = 0.46, 95% CI: 0.36–0.59; P = 0.69), niraparib+SOC (HR = 0.44, 95% CI: 0.26–0.76; P = 0.76), and veliparib+SOC (HR = 0.38, 95% CI: 0.29–0.48; P = 0.91). No heterogeneity or inconsistency was detected (τ² = 0; I² = 0; Q = 1.27, p = 0.53). For PFS, iniparib/gemcitabine, talazoparib, olaparib, and niraparib showed significant reduction in HR with increasing order of P-scores, in combination with SOC. Conclusions: Veliparib combined with SOC showed the highest OS improvement, while niraparib ranked highest for PFS, followed by talazoparib and olaparib. Further trials are needed to confirm these findings and refine treatment strategies for BRCAm, HER2-BC.