info@auctorespublishing.com
+1-(302)-520-2644
+1-(302)-520-2644

A Critical Appraisal of a Decade of Left-Main Revascularization Meta-Analyses

  1. Home
  2. Journals
  3. Cardiology Research and Reports
  4. Archives
Submit Guidelines

Review Article

A Critical Appraisal of a Decade of Left-Main Revascularization Meta-Analyses

  • Christiaan F.J. Antonides 1*
  • Daniel J.F.M. Thuijs 1
  • Edris A.F. Mahtab 1
  • Mattie J. Lenzen 2
  • A. Pieter Kappetein 1
  • Ad J.J.C. Bogers 1
  • Stuart J. Head 1

*Corresponding Author: Christiaan F.J. Antonides, Erasmus University Medical Centre Department of Cardiothoracic Surgery Dr. Molewaterplein 40, 3015GD, Rotterdam, the Netherla

Citation: Christiaan F.J. Antonides, Daniel J.F.M. Thuijs, Edris A.F. Mahtab1 Mattie J. Lenzen, A. Pieter Kappetein, (2020) A Critical Appraisal of a Decade of Left-Main Revascularization Meta-Analyses. J Cardiology Research and Reports 2(1): Doi: 10.31579/2692-9759/006

Copyright: © 2020, Christiaan F.J. Antonides, Daniel J.F.M. Thuijs. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Received: 14 July 2020 | Accepted: 25 July 2020 | Published: 30 July 2020

Keywords: coronary artery bypass, percutaneous coronary intervention, left main, meta-analyses, MACCE, all-cause mortality

Abstract

Background: Determining the optimal revascularization strategy for patients with left main coronary artery disease (LMCAD) is a compelling topic. After the publication of two new trials, numerous meta-analyses on percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) appeared in the literature. This study set out to review the extent of published meta-analyses on PCI versus CABG in LMCAD, and stipulates the need for “quality over quantity”.

Methods: A systematic search in Embase, Medline Ovid and Cochrane databases was performed to identify meta-analyses on PCI versus CABG in LMCAD. Meta-analyses that reported associations between revascularization and clinical outcomes were included. Study outcomes were reported according to descriptive statistics, without pooling study outcomes.
Results: Fifty-one meta-analyses were included. Of those, 33 became available after EXCEL and NOBLE trial publication. The composite of major adverse cardiac (and cerebrovascular) events were reported in 41, and 49 reported all-cause mortality. Results varied among meta-analyses, depending on (i) randomized versus observational data, or a combination of both, (ii) methodology and effect-measures to report treatment-differences, (iii) varying sample sizes, and (iv) the year of publication.

Conclusions: The number of meta-analyses on PCI versus CABG in patients with LMCAD, is disproportionate and urges the need for quality over quantity. To ensure future high-quality publications, we call on all authors, editors and reviewers to appraise the evidence already available and join forces to conduct individual patient data pooled analyses instead.

Introduction

Meta-analyses are systematic reviews that pool study-outcomes to increase statistical power and provide a higher level of evidence than is often possible with single studies. Therefore, meta-analyses are frequently consulted by healthcare professionals and inform medical guidelines [1].

The number of meta-analyses increased substantially in the field of cardiovascular medicine and determining the optimal strategy for patients with left main coronary artery disease (LMCAD) remains a fiercely debated subject. Over the past decades, numerous randomized studies assessed clinical outcomes after percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) in patients with LMCAD.2-6 Two randomized controlled trials (RCTs) that contributed considerably to the evidence are the EXCEL (Evaluation of XIENCE versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) and NOBLE (Nordic Baltic British left main revascularization) trials [7,8]. Additionally, several non-randomized observational studies have reported results of CABG versus PCI. Pooling of observational data with randomized studies may lead to inter-study variability related to study design, sample size, baseline characteristics and outcomes, making it challenging to adequately appraise all scientific evidence available.

A meta-analysis, if performed correctly, can be helpful. However, an excess of meta-analyses, as was noticed over the recent decade, could lead to overlapping and redundant outcomes [9]. Therefore, this study critically appraised the extent of potential overlap and shortcomings by systematically reviewing the contemporaneous published meta-analyses on PCI versus CABG in LMCAD, with a special focus on those published after the EXCEL and NOBLE publications.

Methods

Search strategy. On November 7th, 2018, a systematic literature search, according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline [10]. (Supplementary Appendix), was performed in Embase, Medline Ovid and Cochrane databases to identify meta-analyses on PCI versus CABG in LMCAD. The search contained the following key words or synonyms: “left main coronary artery disease”, “percutaneous coronary intervention”, “coronary artery bypass grafting” and “meta-analysis”. A detailed search strategy is reported in the Supplementary Appendix.

Meta-analyses comparing revascularization strategies for LMCAD, by PCI with any stent(s) versus CABG, and reported clinical outcomes were included. Titles and abstracts were first screened for inclusion. When eligible, full-text English articles were subsequently reviewed independently by two authors (CA and DT). Predefined exclusion criteria were: (i) conference abstracts, (ii) absence of a LMCAD population, (iii) subgroups of patients with LMCAD, (iv) absence of effect estimates, (vi) individual patient pooled analyses or (vii) systematic reviews. Incongruities were resolved by agreement between two authors (CA and DT).

Data extraction. The following study details were extracted: year of publication, authors, journal, number of patients (total, CABG, and PCI) and the number of included individual randomized controlled trials (RCTs) and observational studies. Postoperative outcomes with an effect estimate (hazard, odds, risk ratios or incidence rate ratios) were extracted, along with the model used for analysis (fixed or random effects model). “Combined long-term follow-up” is defined as meta-analyses reporting a pooled event-rate at follow-up with varying durations (e.g. combination of 1, 3 and 5-year follow-up data).

Clinical outcomes that were extracted included major adverse cardiac (and cerebrovascular) events (MAC(C)E), according to the definitions used by the individual included meta-analyses, such as (i) death, stroke or myocardial infarction (MI) or as (ii) death, stroke, MI or any form of repeat revascularization (for example; target-vessel revascularization or ischemia-driven revascularization). All-cause mortality rates were also extracted.

Study outcomes. The primary endpoint consisted of a summary of MAC(C)E and all-cause mortality outcomes at combined long-term follow-up reported by meta-analyses published after EXCEL and NOBLE. Additionally, a summary of MAC(C)E and all-cause mortality outcomes at 1-year and combined long-term follow-up was provided for all included meta-analyses. The present report had no intention to determine which revascularization strategy would be preferable for patients with LMCAD and rather focused on providing an overview of the currently available literature. Therefore, pooled outcomes of treatment effects are not provided.

Statistical analyses. Results are reported according to descriptive methods. All risk estimates reported, reflect a “PCI versus CABG” comparison. When an included meta-analysis reported “CABG versus PCI” risk estimates, these were recalculated to represent “PCI versus CABG” comparisons. Forest plots were used to visualize the spread of varying study outcomes for MAC(C)E and all-cause mortality. Plots were constructed with Prism 8 (GraphPad Software, San Diego, CA, USA).

Results

Study selection. The systematic search resulted in 402 articles. After excluding duplicates, screening titles and abstracts, 128 articles remained for full text reading (Figure 1).

Figure 1. Flowchart of the comprehensive systematic search for meta-analyses PCI versus CABG in LMACD.

Abbreviations used: CABG; coronary artery bypass grafting, PCI; percutaneous coronary intervention, LMCAD: left main coronary artery disease.Of these, 77 were excluded based on the pre-specified criteria. Finally, 51 meta-analyses were included in the present study, of which 33 were published after EXCEL and NOBLE (Table 1 and Supplementary Appendix Table S1) [11.61].

Table 1
Table 1
Table 1. Overview of characteristics on PCI versus CABG in LMCAD published by meta-analysis published after EXCEL and NOBLE trial.

Risk estimates representing CABG versus PCI, provided by included meta-analyses, were recalculated to represent PCI versus CABG risk estimates.  X = YES , - = NO. *this specific outcome was not specified in this meta-analysis. †MAC(C)E was defined according to the study-specific definition used by the included meta-analysis. #the correct reference was missing in the original meta-analysis.
Abbreviations used: CABG: coronary artery bypass grafting, CVA: cerebrovascular accident, PCI: percutaneous coronary intervention, LMCAD: left main coronary artery disease, RCTs: randomized controlled trials, Obs.: Observational, Ref.: reference, LA: longest available follow-up, MI; myocardial revascularization, RR/RRV; repeat revascularization, TVR: target vessel revascularization, ST; stent thrombosis, OR: odds ratio, HR: hazard ratio, RR: risk ratio, IRR: incidence rate ratio, UR: unplanned revascularization.

Published meta-analyses. The number of published meta-analyses increased over the past decade, especially after the publication of the randomized EXCEL and NOBLE trials (Figure 2) [7, 8].

Figure 2. Representation of published randomized clinical trials and meta-analyses on PCI versus CABG in LMCAD over the past decade.

The red bars represent the amount of published meta-analyses per year. The red curve represents the cumulative amount of published meta-analyses over the past decade. The main randomized studies that published data on PCI versus CABG in LMCAD are indicated by black lines and names with the intention-to-treat sample sizes.
Several journals published more than one meta-analysis, with one journal publishing 10 meta-analyses on PCI versus CABG for LMCAD. Meta-analyses predominantly reported risk estimates according to odds, risk or hazard ratios.
Meta-analyses after EXCEL and NOBLE. Thirty-three meta-analyses were published after EXCEL and NOBLE. Of these, 32 included EXCEL and NOBLE in addition to results from 3 or 4 other RCTs in their analysis. MAC(C) E outcomes, at combined long-term follow-up, were reported by 26 studies (Table 1, Figure 3),

Figure 3. Forest plot representation of MAC(C) E outcomes, at longest follow-up available, reported by those meta-analyses published after the NOBLE and EXCEL trials.

Risk estimates represent PCI versus CABG comparisons and were categorized according to: odds, risk, hazard and incidence rate ratios. MAC(C) E was defined according to the study-specific definition used by the included meta-analysis. Legend of shapes used: square: only randomized controlled trials, triangle: randomized controlled trials plus observational studies. Size of a shape does not represent the study sample size nor the weight of a specific study. Black represents random-effect meta-analyses, red fixed-effect meta-analyses. Abbreviations used: CABG; coronary artery bypass grafting, PCI; percutaneous coronary intervention.
While 27 meta-analyses reported all-cause mortality at combined long-term follow-up (Table 1, Figure 4).

Figure 4. Forest plot representation of all-cause mortality outcomes, at longest follow-up available, reported by those meta-analyses published after the NOBLE and EXCEL trials.

Risk estimates represent PCI versus CABG comparisons and were categorized according to: odds, risk, hazard and incidence rate ratios. Legend of shapes used: square: only randomized controlled trials, triangle: randomized controlled trials plus observational studies. Size of a shape does not represent the study sample size nor the weight of a specific study. Black represents random-effect meta-analyses, red fixed-effect meta-analyses.  Abbreviations used: CABG; coronary artery bypass grafting, PCI; percutaneous coronary intervention.
Meta-analyses that included the same RCTs (SYNTAX, Boudriot et al., PRECOMBAT, EXCEL, NOBLE with/without LE MANS) reported varying sample sizes, ranging from 4594 to 4700 patients, while the overall intention-to-treat population consists of 4595 patients (5 RCTs) and 4700 (5 RCTs plus LE MANS, respectively) (Table 1).

Eleven meta-analyses reported MAC(C)E risk estimates at combined long-term follow-up varying from 0.99 (95%CI: 0.70-1.40) to 1.36 (95%CI: 1.18-1.58), although the composite of MAC(C)E differed among trials. MAC(C)E-specific definitions used by the various trials are reported in the Supplementary Appendix (Table S2). Ten meta-analyses reported risk estimates of all-cause mortality at combined long-term follow-up, varying from 0.94 (95%CI: 0.73-1.22) to 1.06 (95%CI:0.82-1.38). Two meta-analyses that also included observational data reported similar outcomes as compared studies only including RCTs [51, 54].

Published meta-analyses over the past decade. Since 2009, 41 meta-analyses reported MAC(C)E outcomes (Table S1). Of those, 33 reported outcomes at combined long-term follow-up (Figure S1) and 22 reported outcomes at 1-year (Table 1, Figure S2). All-cause mortality, at combined long-term follow-up, was reported by 38 meta-analyses (Table S1, Figure S3). Twenty-seven studies reported all-cause mortality at 1-year (Figure S4). Meta-analyses that only included RCTs reported similar all-cause death outcomes compared with those including also observational data.

Discussion

Fifty-one meta-analyses covering the exact same topic were identified, and of these, 33 emerged over the past three years after the publications of the randomized EXCEL and NOBLE trials. Sixteen meta-analyses were published from 2009 to 2013 and this number more than doubled (n=35) from 2014 to 2018. While this study did not perform a meta-analysis of meta-analyses and had no intention on determining the preferred revascularization strategy for LMCAD, it systematically reviewed the abundancy of meta-analyses on PCI versus CABG in LMCAD over the past decade. Interestingly, the reported outcomes differed between meta-analyses due to several methodological reasons. Although meta-analyses (should) aim to present the highest level of evidence, there are multiple shortcomings which are summarized below [9, 61, and 62].

There were methodological limitations in the design of many meta-analyses. The reported sample-sizes varied without explanation. Several studies combined the intention-to-treat populations with as-treated populations. Many (n=38) meta-analyses report all-cause mortality at long-term follow-up, while the duration of follow-up differed significantly between trials. The SYNTAX trial for instance, reported 5-year follow-up, while EXCEL reported 3-year follow-up. Inclusion of studies with different follow-up durations could result in an under- or overestimation of the outcome, as it is well known that risk differences of MI and repeat revascularization diverge over time, favoring CABG.2,7,8,64,65 This is most evident in the landmark analysis of the EXCEL trial for the composite endpoint of death, stroke or MI: 0-30 days (HR: 0.61 (95% CI: 0.42-0.88)) versus >30 days -3 year (HR: 1.44 (95% CI: 1.06-1.96)). [7, 66].

Additionally, the statistical models used in the meta-analyses differed. Besides reporting various effect-measures, meta-analyses either used a random-effect or a fixed-effect model. A fixed-effect model assumes that the treatment-effect is similar across studies, while a random-effect model accounts for differences in treatment effect, study populations or follow-up length [67]. Some of the meta-analyses that included SYNTAX, Boudriot et al., PRECOMBAT, EXCEL and NOBLE used a random-effect model while others used a fixed-effect model. Moreover, meta-analyses that included observational studies, with substantial variations in follow-up time and patients baseline characteristics, used a fixed-effect model.

Finally, composite outcomes with different definitions were pooled. The definitions of MAC(C)E differed among SYNTAX [65], EXCEL [7], and NOBLE (Table S2) [8], but some meta-analyses did not take into account these differences in the composite end-points. This, however, is crucial information for both patient and physicians when deciding on the preferred treatment.

To diminish the overlap in future meta-analyses, it is recommended to register the rationale and protocol of a new meta-analysis at an online registration platform [68]. Finally, a preferable alternative for performing a meta-analysis is to conduct an individual patient data pooled analysis [69, 70]. Pooling individual patient data overcomes the different methods of reporting and analyzing data by individual studies. It has the advantage to use all available raw patients’ characteristics, account for missing variables, use accurate follow-up data and a standardized statistical method for analysis [69].

Conclusion

The present study identified 51 meta-analyses covering the exact same topic of PCI versus CABG revascularization in patients with LMCAD. With the publications of longer-term follow-up of the SYNTAX and EXCEL trials, one could anticipate another surge of meta-analyses. To ensure high quality studies and reduce overlapping publications, we call on all authors, editors and reviewers to critically appraise the evidence already available and use online meta-analyses registration platforms to avoid potential overlap. Collaborating and focusing research capacities, by conducting individual patient data pooled analyses could enable us to work more efficiently and ensure reporting the highest quality of available evidence.

Acknowledgements

We would like to thank Wichor M. Bramer; Biomedical Information Specialist, Medical Library, Erasmus University Medical Centre, Rotterdam, The Netherlands, for his expertise in constructing the comprehensive systematic search.

Conflict Of Interest

Dr. Kappetein and dr. Head report to work as employees of Medtronic, outside the submitted work. All other authors declare no competing interests relevant to this publication.

References

  1. Evidence-Based Medicine Working G. (1992). Evidence-based medicine. A new approach to teaching the practice of medicine. JAMA. 268(17):2420-2425.
    View at Publisher | View at Google Scholar
  2. Morice MC, Serruys PW, Kappetein AP, et al. (2014). Five-year outcomes in patients with left main disease treated with either percutaneous coronary intervention or coronary artery bypass grafting in the synergy between percutaneous coronary intervention with taxus and cardiac surgery trial. Circulation. 129(23):2388-2394.
    View at Publisher | View at Google Scholar
  3. Buszman PE, Buszman PP, Kiesz RS, et al. (2009). Early and long-term results of unprotected left main coronary artery stenting: the LE MANS (Left Main Coronary Artery Stenting) registry. J Am Coll Cardiol. 54(16):1500-1511.
    View at Publisher | View at Google Scholar
  4. Ahn JM, Roh JH, Kim YH, et al. (2015). Randomized Trial of Stents Versus Bypass Surgery for Left Main Coronary Artery Disease: 5-Year Outcomes of the PRECOMBAT Study. J Am Coll Cardiol. 65(20):2198-2206.
    View at Publisher | View at Google Scholar
  5. Boudriot E, Thiele H, Walther T, et al. (2011). Randomized comparison of percutaneous coronary intervention with sirolimus-eluting stents versus coronary artery bypass grafting in unprotected left main stem stenosis. J Am Coll Cardiol. 57(5):538-545.
    View at Publisher | View at Google Scholar
  6. Park S-J, Ahn J-M, Kim Y-H, et al. (2015). Trial of Everolimus-Eluting Stents or Bypass Surgery for Coronary Disease. New England Journal of Medicine. 372(13):1204-1212.
    View at Publisher | View at Google Scholar
  7. Stone GW, Sabik JF, Serruys PW, et al. (2016). Everolimus-Eluting Stents or Bypass Surgery for Left Main Coronary Artery Disease. N Engl J Med. 375(23):2223-2235.
    View at Publisher | View at Google Scholar
  8. Makikallio T, Holm NR, Lindsay M, et al. (2016). Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE): a prospective, randomised, open-label, non-inferiority trial. Lancet. 388(10061):2743-2752.
    View at Publisher | View at Google Scholar
  9. Siontis KC, Hernandez-Boussard T, Ioannidis JP. (2013). Overlapping meta-analyses on the same topic: survey of published studies. BMJ. 347:f4501.
    View at Publisher | View at Google Scholar
  10. Moher D, Liberati A, Tetzlaff J, et al. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. Open Med. 3(3):e123-130.
    View at Publisher | View at Google Scholar
  11. Naik H, White AJ, Chakravarty T, et al. (2009). A Meta-Analysis of 3,773 Patients Treated With Percutaneous Coronary Intervention or Surgery for Unprotected Left Main Coronary Artery Stenosis. JACC Cardiovasc Interventions. 2(8):739-747.
    View at Publisher | View at Google Scholar
  12. Takagi H, Kawai N, Umemoto T. (2009). Stenting versus coronary artery bypass grafting for unprotected left main coronary artery disease: A meta-analysis of comparative studies. J Thorac Cardiovasc Surg. 137(1):e54-e57.
    View at Publisher | View at Google Scholar
  13. Lee MS, Yang T, Dhoot J, et al. (2010). Meta-Analysis of Clinical Studies Comparing Coronary Artery Bypass Grafting With Percutaneous Coronary Intervention and Drug-Eluting Stents in Patients With Unprotected Left Main Coronary Artery Narrowings. Am J Cardiol. 105(8):1070-1075.
    View at Publisher | View at Google Scholar
  14. Takagi H, Matsui M, Umemoto T. (2010). Increased late mortality with percutaneous stenting for unprotected left main coronary artery stenosis relative to coronary artery bypass grafting: A meta-analysis of observational studies. J Thorac Cardiovasc Surg. 139(5):1351-1353.
    View at Publisher | View at Google Scholar
  15. Capodanno D, Stone GW, Morice MC, et al. (2011). Percutaneous coronary intervention versus coronary artery bypass graft surgery in left main coronary artery disease: a meta-analysis of randomized clinical data. J Am Coll Cardiol. 58(14):1426-1432.
    View at Publisher | View at Google Scholar
  16. Zheng S, Zheng Z, Hou J, et al. (2011). Comparison between drug-eluting stents and coronary artery bypass grafting for unprotected left main coronary artery disease: A meta-analysis of two randomized trials and thirteen observational studies. Cardiology. 118(1):22-32.
    View at Publisher | View at Google Scholar
  17. Jang JS, Choi KN, Jin HY, et al. (2012). Meta-analysis of three randomized trials and nine observational studies comparing drug-eluting stents versus coronary artery bypass grafting for unprotected left main coronary artery disease. Am J Cardiol. 110(10):1411-1418.
    View at Publisher | View at Google Scholar
  18. Jiang WB, Zhao W, Huang H, et al. (2012). Meta-analysis of effectiveness of first-generation drug-eluting stents versus coronary artery bypass grafting for unprotected left main coronary disease. Am J Cardiol. 110(12):1764-1772.
    View at Publisher | View at Google Scholar
  19. Kajimoto K, Miyauchi K, Yamamoto T, et al. (2012). Meta-analysis of randomized controlled trials on the treatment of unprotected left main coronary artery disease: One-year outcomes with coronary artery bypass grafting versus percutaneous coronary artery intervention with drug-eluting stent. J Card Surg. 27(2):152-157.
    View at Publisher | View at Google Scholar
  20. Alam M, Huang HD, Shahzad SA, et al. (2013). Percutaneous coronary intervention vs. coronary artery bypass graft surgery for unprotected left main coronary artery disease in the drug-eluting stents era - An aggregate data meta-analysis of 11,148 patients. Circ J. 77(2):372-382.
    View at Publisher | View at Google Scholar
  21. Athappan G, Patvardhan E, Tuzcu ME, et al. (2013). Left main coronary artery stenosis: A meta-analysis of drug-eluting stents versus coronary artery bypass grafting. JACC Cardiovasc Interventions. 6(12):1219-1230.
    View at Publisher | View at Google Scholar
  22. Bittl JA, He Y, Jacobs AK, et al. (2013). Bayesian Methods affirm the use of percutaneous coronary intervention to improve survival in patients with unprotected left main coronary artery disease. Circulation. 127(22):2177-2185.
    View at Publisher | View at Google Scholar
  23. Cao C, Manganas C, Bannon P, et al. (2013). Drug-eluting stents versus coronary artery bypass graft surgery in left main coronary artery disease: A meta-analysis of early outcomes from randomized and nonrandomized studies. J Thorac Cardiovasc Surg. 145(3):738-747.
    View at Publisher | View at Google Scholar
  24. Desch S, Boudriot E, Rastan A, et al. (2013). Bypass surgery versus percutaneous coronary intervention for the treatment of unprotected left main disease: A meta-analysis of randomized controlled trials. Herz. 38(1):48-56.
    View at Publisher | View at Google Scholar
  25. Li Q, Zhang Z, Yin RX. (2013). Drug-eluting stents or coronary artery bypass grafting for unprotected left main coronary artery disease: a meta-analysis of four randomized trials and seventeen observational studies Review. Trials. 14:133.
    View at Publisher | View at Google Scholar
  26. Sá MP, Soares AM, Lustosa PC, et al. (2013). Meta-analysis of 5,674 patients treated with percutaneous coronary intervention and drug-eluting stents or coronary artery bypass graft surgery for unprotected left main coronary artery stenosis. Eur J Cardiothorac Surg. 43(1):73-80.
    View at Publisher | View at Google Scholar
  27. Al Ali J, Franck C, Filion KB, et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention with first-generation drug-eluting stents: a meta-analysis of randomized controlled trials. JACC Cardiovasc Interv. 2014;7(5):497-506.
    View at Publisher | View at Google Scholar
  28. Benedetto U, Ng C, Smith R, et al. (2014). Coronary artery bypass grafting is superior to first-generation drug-eluting stents for unprotected left main coronary artery disease: An updated meta-analysis of 4 randomized, controlled trials. J Thorac Cardiovasc Surg. 148(5):2430-2432.
    View at Publisher | View at Google Scholar
  29. Nerlekar N, Ha FJ, Verma KP, et al. (2016). Percutaneous coronary intervention using drug-eluting stents versus coronary artery bypass grafting for unprotected left main coronary artery stenosis. Circ Cardiovasc Interventions. 9(12).
    View at Publisher | View at Google Scholar
  30. Bajaj NS, Patel N, Kalra R, et al. (2017). Percutaneous coronary intervention vs. coronary artery bypass grafting for left main revascularization: An updated meta-analysis. Eur Heart J Qual Care Clin Outcomes. 3(3):173-182.
    View at Publisher | View at Google Scholar
  31. Chang YS, Wang JX, Chang DW. (2017). Outcomes of Coronary Artery Bypass and Stents for Unprotected Left Main Coronary Stenosis. Ann Thorac Surg. 104(2):630-637.
    View at Publisher | View at Google Scholar
  32. De Rosa S, Polimeni A, Sabatino J, et al. (2017). Long-term outcomes of coronary artery bypass grafting versus stent-PCI for unprotected left main disease: a meta-analysis Review. BMC Cardiovasc Disord. 17(1):240.
    View at Publisher | View at Google Scholar
  33. Gao L, Liu Y, Sun Z, et al. (2017). Percutaneous coronary intervention using drug-eluting stents versus coronary artery bypass graft surgery in left main coronary artery disease an updated meta-analysis of randomized clinical trials. Oncotarget. 8(39):66449-66457.
    View at Publisher | View at Google Scholar
  34. Garg A, Rao SV, Agrawal S, et al. (2017). Meta-Analysis of Randomized Controlled Trials of Percutaneous Coronary Intervention With Drug-Eluting Stents Versus Coronary Artery Bypass Grafting in Left Main Coronary Artery Disease. Am J Cardiol. 119(12):1942-1948.
    View at Publisher | View at Google Scholar
  35. Giacoppo D, Colleran R, Cassese S, et al. (2017). Percutaneous Coronary Intervention vs Coronary Artery Bypass Grafting in Patients With Left Main Coronary Artery Stenosis: A Systematic Review and Meta-analysis. JAMA Cardiol. 2(10):1079-1088.
    View at Publisher | View at Google Scholar
  36. Khan AR, Golwala H, Tripathi A, et al. (2017). Meta-analysis of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Left Main Coronary Artery Disease. Am J Cardiol. 119(12):1949-1956.
    View at Publisher | View at Google Scholar
  37. Khan MR, Kayani WT, Ahmad W, et al. (2017). Meta-Analysis of Comparison of 5-Year Outcomes of Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With Unprotected Left Main Coronary Artery in the Era of Drug-eluting Stents. Am J Cardiol. 120(9):1514-1520.
    View at Publisher | View at Google Scholar
  38. Laukkanen JA, Kunutsor SK, Niemela M, et al. (2017). All-cause mortality and major cardiovascular outcomes comparing percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of unprotected left main stenosis: a meta-analysis of short-term and long-term randomised trials. Open Heart. 4(2):e000638.
    View at Publisher | View at Google Scholar
  39. Mahmoud AN, Elgendy IY, Mentias A, et al. (2017). Percutaneous coronary intervention or coronary artery bypass grafting for unprotected left main coronary artery disease. Catheter Cardiovasc Interventions. 90(4):541-552.
    View at Publisher | View at Google Scholar
  40. Palmerini T, Serruys P, Kappetein AP, et al. (2017). Clinical outcomes with percutaneous coronary revascularization vs coronary artery bypass grafting surgery in patients with unprotected left main coronary artery disease: A meta-analysis of 6 randomized trials and 4,686 patients. Am Heart J. 190:54-63.
    View at Publisher | View at Google Scholar
  41. Putzu A, Gallo M, Martino EA, et al. (2017). Coronary artery bypass graft surgery versus percutaneous coronary intervention with drug-eluting stents for left main coronary artery disease: A meta-analysis of randomized trials. Int J Cardiol. 241:142-148.
    View at Publisher | View at Google Scholar
  42. Qian C, Feng H, Cao J, et al. (2017). Meta-Analysis of Randomized Control Trials Comparing Drug-Eluting Stents Versus Coronary Artery Bypass Grafting for Significant Left Main Coronary Narrowing. Am J Cardiol. 119(9):1338-1343.
    View at Publisher | View at Google Scholar
  43. Sá MPBO, Soares AF, Miranda RGA, et al. (2017). CABG Surgery Remains the best Option for Patients with Left Main Coronary Disease in Comparison with PCI-DES: Meta-Analysis of Randomized Controlled Trials. Braz J Cardiovasc Surg. 32(5):408-416.
    View at Publisher | View at Google Scholar
  44. Sardar P, Giri J, Elmariah S, et al. (2017). Meta-Analysis of Drug-Eluting Stents Versus Coronary Artery Bypass Grafting in Unprotected Left Main Coronary Narrowing. Am J Cardiol. 119(11):1746-1752.
    View at Publisher | View at Google Scholar
  45. Shah R, Morsy MS, Weiman DS, et al. (2017). Meta-Analysis Comparing Coronary Artery Bypass Grafting to Drug-Eluting Stents and to Medical Therapy Alone for Left Main Coronary Artery Disease. Am J Cardiol. 120(1):63-68.
    View at Publisher | View at Google Scholar
  46. Sharma SP, Dahal K, Khatra J, et al. (2017). Percutaneous coronary intervention vs coronary artery bypass grafting for left main coronary artery disease? A systematic review and meta-analysis of randomized controlled trials. Cardiovasc Ther. 35(3).
    View at Publisher | View at Google Scholar
  47. Spinthakis N, Farag M, Gorog DA, et al. (2017). Percutaneous coronary intervention with drug-eluting stent versus coronary artery bypass grafting: A meta-analysis of patients with left main coronary artery disease. Int J Cardiol. 249:101-106.
    View at Publisher | View at Google Scholar
  48. Testa L, Latib A, Bollati M, et al. (2017). Unprotected left main revascularization: Percutaneous coronary intervention versus coronary artery bypass. An updated systematic review and meta-analysis of randomised controlled trials. PLoS ONE. 12(6).
    View at Publisher | View at Google Scholar
  49. Upadhaya S, Baniya R, Madala S, et al. (2017). Drug-eluting stent placement versus coronary artery bypass surgery for unprotected left main coronary artery disease: A meta-analysis of randomized controlled trials. J Card Surg. 32(2):70-79.
    View at Publisher | View at Google Scholar
  50. Ye Y, Yang M, Zhang S, et al. (2017). Percutaneous coronary intervention versus cardiac bypass surgery for left main coronary artery disease: A trial sequential analysis. Medicine (Baltimore). 96(41):e8115.
    View at Publisher | View at Google Scholar
  51. Zhang XL, Zhu QQ, Yang JJ, et al. (2017). Percutaneous intervention versus coronary artery bypass graft surgery in left main coronary artery stenosis: a systematic review and meta-analysis Review. BMC Med. 15(1):84.
    View at Publisher | View at Google Scholar
  52. Ali WE, Vaidya SR, Ejeh SU, et al. (2018). Meta-analysis study comparing percutaneous coronary intervention/drug eluting stent versus coronary artery bypass surgery of unprotected left main coronary artery disease: Clinical outcomes during short-term versus long-term (> 1 year) follow-up. Medicine (Baltimore). 97(7):e9909.
    View at Publisher | View at Google Scholar
  53. Benedetto U, Taggart DP, Sousa-Uva M, et al. (2018). New-generation stents compared with coronary bypass surgery for unprotected left main disease: A word of caution. J Thorac Cardiovasc Surg. 155(5):2013-2019.e2016.
    View at Publisher | View at Google Scholar
  54. Bertaina M, De Filippo O, Iannaccone M, et al. (2018). Percutaneous coronary intervention or coronary artery bypass graft in left main coronary artery disease: a comprehensive meta-analysis of adjusted observational studies and randomized controlled trials. J Cardiovasc Med (Hagerstown). 19(10):554-563.
    View at Publisher | View at Google Scholar
  55. Cui KY, Lyu SZ, Song XT, et al. (2018). Long term outcomes of drug-eluting stent versus coronary artery bypass grafting for left main coronary artery disease: A meta-analysis. J Geriatr Cardiol. 15(2):162-172.
    View at Publisher | View at Google Scholar
  56. Khan SU, Rahman H, Arshad A, et al. (2018). Percutaneous Coronary Intervention Versus Surgery in Left Main Stenosis–A Meta-Analysis and Systematic Review of Randomised Controlled Trials. Heart Lung Circul. 27(2):138-146.
    View at Publisher | View at Google Scholar
  57. Kodumuri V, Balasubramanian S, Vij A, et al. (2018). A Meta-Analysis Comparing Percutaneous Coronary Intervention With Drug-Eluting Stents Versus Coronary Artery Bypass Grafting in Unprotected Left Main Disease. Am J Cardiol. 121(8):924-933.
    View at Publisher | View at Google Scholar
  58. Moore P, Burrage M, Garrahy P, et al. (2018). Drug-Eluting Stents Versus Coronary Artery Bypass Grafts for Left Main Coronary Disease: A Meta-Analysis and Review of Randomised Controlled Trials. Heart Lung Circul. 27(12):1437-1445.
    View at Publisher | View at Google Scholar
  59. Rahouma M, Abouarab A, Di Franco A, et al. (2018). Percutaneous coronary intervention versus coronary bypass surgery for unprotected left main disease: a meta-analysis of randomized controlled trials. Ann. cardiothorac. surg. 7(4):454-462.
    View at Publisher | View at Google Scholar
  60. Takagi H, Ando T, Umemoto T. (2018). Drug-eluting stents versus coronary artery bypass grafting for left-main coronary artery disease. Catheter Cardiovasc Interventions. 91(4):697-709.
    View at Publisher | View at Google Scholar
  61. Verdoia M, Barbieri L, Kedhi E, et al. (2018). Percutaneous Versus Surgical Revascularization for Left Main or Multivessel Coronary Artery Disease: Results From a Large-Scale Meta-Analysis in the Era of Drug-Eluting Stents. Angiology. 69(9):812-824.
    View at Publisher | View at Google Scholar
  62. Higgins J, Thompson S, Deeks J, et al. (2002). Statistical heterogeneity in systematic reviews of clinical trials: a critical appraisal of guidelines and practice. J Health Serv Res Policy. 7(1):51-61.
    View at Publisher | View at Google Scholar
  63. Ioannidis JP. (2016). The Mass Production of Redundant, Misleading, and Conflicted Systematic Reviews and Meta-analyses. Milbank Q. 94(3):485-514.
    View at Publisher | View at Google Scholar
  64. Mohr FW, Morice MC, Kappetein AP, et al. (2013). Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet. 381(9867):629-638.
    View at Publisher | View at Google Scholar
  65. Serruys P, Morice M, Kappetein A, et al. (2009). Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med. 360(10):961-972.
    View at Publisher | View at Google Scholar
  66. Ruel M, Falk V, Farkouh ME, et al. (2018). Myocardial Revascularization Trials. Circulation. 138(25):2943-2951.
    View at Publisher | View at Google Scholar
  67. Riley RD, Higgins JP, Deeks JJ. (2011). Interpretation of random effects meta-analyses. BMJ. 342:d549.
    View at Publisher | View at Google Scholar
  68. PROSPERO. 2019; https://www.crd.york.ac.uk/PROSPERO/.
    View at Publisher | View at Google Scholar
  69. Riley RD, Lambert PC, Abo-Zaid G. (2010). Meta-analysis of individual participant data: rationale, conduct, and reporting. BMJ. 340:c221.
    View at Publisher | View at Google Scholar
  70. da Costa BR, Juni P. (2014). Systematic reviews and meta-analyses of randomized trials: principles and pitfalls. Eur Heart J. 35(47):3336-3345.
    View at Publisher | View at Google Scholar

Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.

img

Virginia E. Koenig

Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.

img

Delcio G Silva Junior

Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.

img

Ziemlé Clément Méda

Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.

img

Mina Sherif Soliman Georgy

We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.

img

Layla Shojaie

The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.

img

Sing-yung Wu

Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.

img

Orlando Villarreal

Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.

img

Katarzyna Byczkowska

Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.

img

Anthony Kodzo-Grey Venyo

Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.

img

Pedro Marques Gomes

Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.

img

Bernard Terkimbi Utoo

This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.

img

Prof Sherif W Mansour

Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.

img

Hao Jiang

As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.

img

Dr Shiming Tang

Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.

img

Raed Mualem

International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.

img

Andreas Filippaios

Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.

img

Dr Suramya Dhamija

Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.

img

Bruno Chauffert

I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!

img

Baheci Selen

"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".

img

Jesus Simal-Gandara

I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.

img

Douglas Miyazaki

We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.

img

Dr Griffith

I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.

img

Dr Tong Ming Liu

I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.

img

Husain Taha Radhi

I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.

img

S Munshi

Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.

img

Tania Munoz

“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.

img

George Varvatsoulias

Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.

img

Rui Tao

Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.

img

Khurram Arshad

Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.

img

Gomez Barriga Maria Dolores

The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.

img

Lin Shaw Chin

Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.

img

Maria Dolores Gomez Barriga

Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.

img

Dr Maria Dolores Gomez Barriga

Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.

img

Dr Maria Regina Penchyna Nieto

Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.

img

Dr Marcelo Flavio Gomes Jardim Filho

Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”

img

Zsuzsanna Bene

Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner

img

Dr Susan Weiner