Background: Multiple chemotherapeutic agents, such as anthracyclines, have recently shown a fatal potential for cardiotoxic effects in their patients. However, their efficacy is often hindered by their harmful adverse effects, mostly cardiotoxicity. DM medications such as metformin, SGLT-2 inhibitors, and GLP-1 receptor agonists have exhibited promising cardioprotective properties in rat clinical trials. Purpose: We conducted our study to investigate the observational association between diabetic medications and Cardioprotective effect in cancer patients treated with cardiotoxic chemotherapeutics. Methods: A meta-analysis following PRISMA guidelines included observational studies comparing diabetic cancer patients treated with chemotherapy. Outcomes evaluated were heart failure (HF) incidence, HF exacerbation, atrial fibrillation (AF), hospitalization, and mortality. Data were independently extracted by five investigators from multiple databases up to January 20, 2025. Results: Eight studies involving 27,015 patients were included. DM medication use may be associated with lower mortality (OR 0.50, p < 0.00001), HF incidence (OR 0.36, p = 0.007), HF exacerbation (OR 0.58, p < 0.0001), although heterogeneity was significant. Subgroup analysis revealed that SGLT-2 inhibitors may be associated with reduced mortality by 50%, HF incidence by 64%, and HF exacerbation by 49%. Hazard ratio analysis indicated SGLT-2 inhibitors use was associated with lower mortality risk in patients receiving cardiotoxic chemotherapy (HR 0.58, p = 0.001). Conclusion: Diabetic medications, particularly SGLT-2 inhibitors, may be associated with observational cardioprotective effect in cancer patients undergoing cardiotoxic chemotherapy. These findings highlight the need for further prospective trials to confirm subgroup benefits.

Primary percutaneous coronary intervention (PCI) achieves epicardial reperfusion in most STEMI patients, yet microvascular obstruction persists in up to 60% of patients. Excimer laser coronary angioplasty (ELCA) vaporizes thrombus in situ and may reduce distal embolization, but the evidence base has not been systematically synthesized. This systematic review and meta-analysis (PROSPERO CRD420261422463) included comparative studies of adjunctive ELCA versus aspiration thrombectomy (Stratum A) or PCI alone (Stratum B) in acute coronary occlusion. Primary outcomes were final TIMI-3 flow and myocardial blush grade (MBG) 3; secondary outcomes were short-term mortality, MACCE, and slow-flow/no-reflow. A random-effects model with Hartung-Knapp-Sidik-Jonkman confidence intervals was applied to all outcomes. Certainty was assessed with GRADE. Ten studies (1 RCT, 9 observational) were included, from a total enrolled population exceeding 3,500. In Stratum A, no outcome reached significance: MBG-3 (OR 3.57, 95% CI 0.07–185.10), mortality (OR 0.31, 0.02–4.04), MACCE (OR 0.22, 0.04–1.26), TIMI-3 flow (OR 1.58, 0.67–3.75) and slow-flow/no-reflow (OR 0.78, 0.22–2.78). In Stratum B, using each study’s propensity-matched data, no outcome differed significantly (TIMI-3 OR 0.88, 0.38–2.03; MBG-3 OR 1.06, 0.13–8.43; slow-flow/no-reflow OR 0.93, 0.29–3.02; mortality OR 0.44, 0.05–3.80). Composite endpoints were not pooled across incompatible follow-up horizons, and all outcomes were of very low certainty. Adjunctive ELCA-containing strategies during primary PCI were not associated with improved angiographic or short-term clinical outcomes against either comparator. Multicenter randomized trials are required before recommending clinical adoption. Graphical abstract Clinical Rationale, Methodological Framework, and Outcomes of Adjunctive Excimer Laser Coronary Angioplasty (ELCA) in Acute Coronary Occlusion. This graphical abstract summarizes the clinical unmet need, intervention methodology, and pooled quantitative evidence evaluating the efficacy of adjunctive ELCA during primary percutaneous coronary intervention (PCI). The synthesis encompasses 10 comparative studies (1 RCT, 9 observational) comprising over 3,500 patients, pre-specified into two comparator strata (mechanical aspiration thrombectomy vs. PCI alone using matched data). CI: confidence interval; ELCA: excimer laser coronary angioplasty; GLMM: generalized linear mixed model; GRADE: Grading of Recommendations Assessment, Development and Evaluation; HK-SJ: Hartung-Knapp-Sidik-Jonkman; MACCE: major adverse cardiovascular and cerebrovascular events; MBG: myocardial blush grade; MVO: microvascular obstruction; NS: not significant; OR: odds ratio; PCI: percutaneous coronary intervention; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PROSPERO: International Prospective Register of Systematic Reviews; RCT: randomized controlled trial; STEMI: ST-elevation myocardial infarction; TIMI: Thrombolysis in Myocardial Infarction.

CKD patients are susceptible to pneumoperitoneum-induced renal injury; comparative outcomes of robotic versus laparoscopic inguinal hernia repair are unknown. Retrospective propensity score–matched cohort using TriNetX (184 HCOs; 2015–2026). CKD adults undergoing robotic or laparoscopic inguinal hernia repair were matched 1:1 on 61 covariates (1,693 per arm at 1 month; 1,659 at 6 months). Primary outcomes were AKI and MACE; secondary outcomes were metabolic acidosis, urinary retention, hyperkalemia, and post-operative eGFR and creatinine. Cox regression, Kaplan–Meier, and competing-risk CIF were used, with E-values for unmeasured confounding. At 1 month, robotic repair had higher AKI (5.0% vs. 2.9%; HR 1.74, 95% CI 1.22–2.47; p = 0.002) and MACE (2.5% vs. 1.4%; HR 1.84; p = 0.017). At 6 months, AKI persisted (HR 1.41; p = 0.002) and urinary retention emerged (HR 1.33; p = 0.039); MACE (p = 0.112) and acidosis (p = 0.199) did not. New-onset hyperkalemia was lower with robotic (HR 0.58; p = 0.045). eGFR MDRD declined less at 1 month (Δ − 1.28 vs. − 3.21; p = 0.049); 6-month creatinine was lower (p = 0.013). CIF (deaths 1.5% vs. 1.9%) confirmed AKI; KM overstated 6-month incidence by 1.1–1.9 points. 1-month AKI E-value 2.87 (CI 1.74). Robotic inguinal hernia repair in CKD was associated with higher AKI and early MACE in the all-events analysis, but the incident AKI signal was borderline and post-operative laboratory renal function favored the robotic arm. This discordance may reflect differential ascertainment at robotic-predominant academic centers. These hypothesis-generating findings do not establish a renal safety advantage for either approach; prospective validation with KDIGO-defined AKI endpoints is required. Graphical abstract