Background/Objectives: Despite the potential benefits, intravascular imaging for guiding percutaneous coronary intervention (PCI) remains underutilized. Recent trials have provided new data, prompting a need for updated insights. This study aimed to perform a comprehensive meta-analysis to compare the clinical outcomes of intravascular imaging-guided PCI versus angiography-guided PCI, thereby evaluating the relative effectiveness of these two guidance strategies in improving patient outcomes. Methods: PubMed, Cochrane Library, Embase and Clinicaltrials.gov databases were systematically searched from inception till 25 November 2024. Randomized clinical trials (RCTs) comparing intravascular imaging with coronary angiography in patients undergoing complex PCI were included. Statistical analysis was conducted using a random effects model to calculate pooled risk ratios with 95% confidence intervals (CI). Results: In this meta-analysis of 21 studies involving 18,043 patients, intravascular image-guided PCI significantly reduced the risk of all-cause mortality by 24%, cardiac mortality by 63%, MACE by 35%, target vessel myocardial infarction by 32%, stent thrombosis by 42%, target vessel revascularization by 45%, target lesion revascularization by 34% and myocardial infarction by 22% compared to angiography-guided PCI. There was no significant difference in bleeding events. Conclusions: Intravascular imaging significantly reduces cardiac events, all-cause mortality and revascularization rates in PCI patients. These findings support its broader adoption and potential updates to clinical guidelines.

Procedural sedation and analgesia (PSA) ensure patient comfort during invasive procedures. While propofol is widely used, its risks include hypotension and bradycardia. Combining it with esketamine may improve sedation and reduce side effects. This meta-analysis evaluates the safety and efficacy of esketamine-propofol combinations compared to alternative PSA regimens. A systematic search was conducted across PubMed, Cochrane Central, and Google Scholar, identifying 20 studies involving 2023 patients. These studies compared esketamine-propofol combinations with other PSA regimens. Statistical analyses were performed via Review Manager 5.4 using the Mantel-Haenszel and inverse variance models, with heterogeneity assessed using the Higgins I² statistic. Sensitivity and subgroup analyses were performed to address significant heterogeneity. The esketamine-propofol combination significantly reduced the risk of bradycardia (RR: 0.42, 95% CI 0.25-0.71, P=0.001) and hypotension (RR: 0.40, 95% CI 0.30-0.53, P<0.01). Propofol consumption was markedly lower in the intervention group (std MD: -1.86, 95% CI -2.53 to -1.18, P<0.01), and so was the injection pain (RR: 0.36, 95% CI 0.19-0.70, P=0.003). The risk of respiratory depression also decreased remarkably compared to the control (RR: 0.32, 95% CI 0.16-0.64, P=0.001). However, no significant differences in the recovery time and the incidence of nausea, vomiting, and tachycardia were observed. The esketamine-propofol combination offers a safer and more effective PSA regimen, minimizing cardiovascular and respiratory complications while enhancing analgesia and reducing the need for higher propofol doses.

BACKGROUND Ketone bodies, especially β-hydroxybutyrate, have shown the potential to improve hemodynamic outcomes such as cardiac output (CO) and left ventricular ejection fraction (LVEF) in patients with heart failure (HF). However, the overall effectiveness of ketone body supplementation in this population remains uncertain. Therefore, we conducted this systematic review and meta-analysis to evaluate the impact of ketone body supplementation on cardiac and hemodynamic parameters in patients with HF while accounting for the limited and emerging nature of the available randomized evidence. AIM To evaluate the impact of ketone body supplementation on cardiac and hemodynamic parameters in patients with HF while accounting for the limited and emerging nature of the available randomized evidence. METHODS A systematic search of PubMed, Scopus, EMBASE, and the Cochrane Central Register of Controlled Trials was conducted from inception to March 2025, with additional screening of ClinicalTrials.gov for unpublished or ongoing trials. Randomized controlled trials (RCTs) comparing ketone body supplementation with placebo in patients with HF were included. Statistical analyses were performed using a random-effects model in RevMan 5.4 to calculate weighted mean differences (MDs) with 95% confidence intervals (CIs). Outcomes assessed included CO, systemic vascular resistance, LVEF, heart rate, venous oxygen saturation, pulmonary capillary wedge pressure, and other cardiac functional indices. Given the small number of included studies, subgroup analyses were considered exploratory. RESULTS Four randomized controlled trials involving a total of 94 patients were included. Compared with placebo, ketone supplementation was associated with a significant increase in CO (MD = 1.11, 95%CI: 0.13-2.09, P = 0.03) and a reduction in systemic vascular resistance (MD = -252.61, 95%CI: -475.72 to -29.50, P = 0.03). Improvements were also observed in LVEF (MD = 3.31, 95%CI: 0.39-6.22, P = 0.03), venous oxygen saturation (MD = 3.33, 95%CI: -0.01 to 6.68, P = 0.05), and pulmonary capillary wedge pressure (MD = -1.09, 95%CI: -1.60 to -0.59, P < 0.0001), along with an increase in heart rate (MD = 4.08, 95%CI: 3.00-5.17, P < 0.0001). Subgroup analyses by HF phenotype (HF with reduced ejection fraction vs HF with preserved ejection fraction) suggested differential effects; however, several subgroups included only one study and should be interpreted as hypothesis-generating only. No statistically significant changes were observed in global longitudinal strain, left ventricular end-diastolic volume, or tricuspid annular plane systolic excursion, and substantial heterogeneity and potential small-study effects limit the robustness of pooled estimates. CONCLUSION Ketone body supplementation was associated with short-term improvements in selected hemodynamic and cardiac functional parameters in patients with HF. However, these findings are based on a small number of short-duration trials with limited sample sizes and crossover designs, precluding firm clinical conclusions. Larger, well-powered randomized trials with longer follow-up are required to confirm the therapeutic role, optimal dosing, and clinical impact of ketone supplementation in HF.