Inflammation is a key factor of myocardial damage in reperfused ST-segment-elevation myocardial infarction. We hypothesized that colchicine, a potent anti-inflammatory agent, may reduce infarct size ...(IS) and left ventricular (LV) remodeling at the acute phase of ST-segment-elevation myocardial infarction.
In this double-blind multicenter trial, we randomly assigned patients admitted for a first episode of ST-segment-elevation myocardial infarction referred for primary percutaneous coronary intervention to receive oral colchicine (2-mg loading dose followed by 0.5 mg twice a day) or matching placebo from admission to day 5. The primary efficacy outcome was IS determined by cardiac magnetic resonance imaging at 5 days. The relative LV end-diastolic volume change at 3 months and IS at 3 months assessed by cardiac magnetic resonance imaging were among the secondary outcomes.
We enrolled 192 patients, 101 in the colchicine group and 91 in the control group. At 5 days, the gadolinium enhancement-defined IS did not differ between the colchicine and placebo groups with a mean of 26 interquartile range (IQR) 16-44 versus 28.4 IQR 14-40 g of LV mass, respectively (
=0.87). At 3 months follow-up, there was no significant difference in LV remodeling between the colchicine and placebo groups with a +2.4% (IQR, -8.3% to 11.1%) versus -1.1% (IQR, -8.0% to 9.9%) change in LV end-diastolic volume (
=0.49). Infarct size at 3 months was also not significantly different between the colchicine and placebo groups (17 IQR 10-28 versus 18 IQR 10-27 g of LV mass, respectively;
=0.92). The incidence of gastrointestinal adverse events during the treatment period was greater with colchicine than with placebo (34% versus 11%, respectively;
=0.0002).
In this randomized, placebo-controlled trial, oral administration of high-dose colchicine at the time of reperfusion and for 5 days did not reduce IS assessed by cardiac magnetic resonance imaging. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03156816.
Transcatheter aortic valve replacement (TAVR) has emerged as a viable treatment for aortic valve disease, including low-risk patients. However, as TAVR usage increases, concerns about long-term ...durability and the potential for addition interventions have arisen. Transcatheter aortic valve (TAV)-in-TAV procedures have shown promise in selected patients in numerous registries, offering a less morbid alternative to TAVR explantation. In this review, the authors aimed to comprehensively review the experience surrounding TAV-in-TAV, summarize available data, discuss pre-procedural planning, highlight associated challenges, emphasize the importance of coronary obstruction assessment and provide insights into the future of this technique.
Ventricular septal rupture (VSR) is a serious complication of ST-elevation myocardial infarction (STEMI) and surgery is the reference treatment. We aimed at describing trends in management and ...mortality during the last four decades and reporting mortality predictors in these patients. We conducted a single-center retrospective study of patients sustaining a VSR from 1981 to 2020. We screened 274 patients and included 265 for analysis. The number of patients decreased over the years: 80, 88, 56, and 50 in each 10-year time span. In-hospital mortality decreased significantly since 1990 (logrank 0.007). The median age was 72.0 years IQR 66–78 and 188 patients (70.9%) were operated on. IABP was used more routinely (
p
< 0.0001). In-hospital mortality was assessed at 66.8% (177 patients) and main predictors of death were a time from MI to surgery < 8 days HR 2.7 IC95% 1.9–3.8
p
< 0.0001, a Killip class > 2 HR 2.5 IC 1.9–3.4
p
< 0.0001 and Euroscore 2 > 20 HR 2.4 IC 1.8–3.2
p
< 0.0001. A “time from MI to surgery” of 8 days offers the best ability to discriminate between patients with or without mortality. The ability of “Euroscore 2 and Killip” to detect the patients most likely to wait 8 days for surgery was at 0.81 0.73–0.89
p
< 0.0001. Mortality remains high over the years. Euroscore 2, Killip class, and time from MI to surgery are the main mortality predictors. Patients with a Killip < 3 and a Euroscore < 20 should be monitored at least 8 days since MI before being referred to surgery.
In this article, a data generated from impacts of objects with different shapes, masses, and impact velocities on a developed dummy head. The mass considered was in the range of 0.3–0.5 kg while the ...shapes considered were cube, wedge, and cylinder. The impact velocities levels were in the range of 1–3 m/s. A total of 144 experiments were conducted and the corresponding videos and raw data were analyzed for impact velocity, peak head linear acceleration, 3 ms criterion, and the Head Injury Criterion (HIC). This dataset includes the raw acceleration data and a summary of the overall processed data. The data is available on Harvard Dataverse: https://doi.org/10.7910/DVN/AVC8GG.
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Anthropomorphic test dummies are commonly used to evaluate the potential harm to humans due to dangerous scenarios, such as that due to car accidents. Furthermore, they have been used ...in sports to evaluate the efficacy of protective gears in mitigating harm due to impacts. Recently, they have been considered in industrial and collaborative robotics to assess risks due interactions between a human and a robot. In this article, we describe the development of a low-cost dummy head impact rig. The motivation behind this project is to quantify the potential harm to a child’s head due to impacts with a small robotic toy. Three severity indices can be estimated, namely, Head Acceleration Criterion (HIC), 3 ms criterion, and peak head acceleration. Furthermore, the artificial skin of the dummy head can be used to assess the potential for tissue injuries. 3D-printed parts were used to develop the head. A tri-axial accelerometer embedded inside the head was used to measure the changes in accelerations. The developed head was placed inside a dedicated experimental bench. A data acquisition card that is connected to a computer system was used to acquire the raw data and then store it. A script was used to postprocess the stored data for the three severity indices. A video camera recording in slow-motion was used to record the impacts. The calculation of the impact velocities was based on the analysis of the video recordings using an open-source software. The developed experimental setup was validated by producing comparable results to that of relevant previous studies.
The coronary angiogram is the gold standard for evaluating the severity of coronary artery disease stenoses. Presently, the assessment is conducted visually by cardiologists, a method that lacks ...standardization. This study introduces DeepCoro, a ground-breaking AI-driven pipeline that integrates advanced vessel tracking and a video-based Swin3D model that was trained and validated on a dataset comprised of 182,418 coronary angiography videos spanning 5 years. DeepCoro achieved a notable precision of 71.89% in identifying coronary artery segments and demonstrated a mean absolute error of 20.15% (95% CI: 19.88-20.40) and a classification AUROC of 0.8294 (95% CI: 0.8215-0.8373) in stenosis percentage prediction compared to traditional cardiologist assessments. When compared to two expert interventional cardiologists, DeepCoro achieved lower variability than the clinical reports (19.09%; 95% CI: 18.55-19.58 vs 21.00%; 95% CI: 20.20-21.76, respectively). In addition, DeepCoro can be fine-tuned to a different modality type. When fine-tuned on quantitative coronary angiography assessments, DeepCoro attained an even lower mean absolute error of 7.75% (95% CI: 7.37-8.07), underscoring the reduced variability inherent to this method. This study establishes DeepCoro as an innovative video-based, adaptable tool in coronary artery disease analysis, significantly enhancing the precision and reliability of stenosis assessment.
Ongoing debate remains regarding optimal antithrombotic therapy in patients with atrial fibrillation (AF) and coronary artery disease.
We performed a systematic review and meta-analysis to synthesize ...randomized controlled trials (RCTs) comparing the following: (i) dual-pathway therapy (DPT; oral anticoagulant OAC plus antiplatelet) vs triple therapy (OAC and dual-antiplatelet therapy) after percutaneous coronary intervention (PCI) or acute coronary syndrome (ACS), and (iii) OAC monotherapy vs DPT at least 1 year after PCI or ACS. Following a 2-stage process, we identified systematic reviews published between 2019 and 2022 on these 2 clinical questions, and we updated the most comprehensive search for additional RCTs published up to October 2022. Outcomes of interest were major adverse cardiovascular events (MACE), death, stent thrombosis, and major bleeding. We estimated risk ratios (RRs) and 95% confidence intervals (CIs) using a random-effects model.
Based on 6 RCTs (n = 10,435), DPT reduced major bleeding (RR 0.62, 95% CI 0.52-0.73) and increased stent thrombosis (RR 1.55, 95% CI 1.02-2.36), vs triple therapy after PCI or medically-managed ACS, with no significant differences in MACE and death. In 2 RCTs (n = 2905), OAC monotherapy reduced major bleeding (RR 0.66, 95% CI 0.49-0.91) vs DPT in AF patients with remote PCI or ACS, with no significant differences in MACE or death.
In patients with AF and coronary artery disease, using less-aggressive antithrombotic treatment (DPT after PCI or ACS, and OAC alone after remote PCI or ACS) reduced major bleeding, with an increase in stent thrombosis with recent PCI. These results support a minimalist yet personalized antithrombotic strategy for these patients.
La question du traitement antithrombotique optimal chez les personnes présentant une fibrillation auriculaire (FA) et une coronaropathie demeure controversée.
Nous avons réalisé une revue systématique et une méta-analyse pour synthétiser les essais contrôlés randomisés ayant comparé i) la bithérapie (anticoagulant oral et antiplaquettaire) et la trithérapie (anticoagulant oral et bithérapie antiplaquettaire) après une intervention coronarienne percutanée (ICP) ou un syndrome coronarien aigu (SCA), et ii) un anticoagulant oral en monothérapie et la bithérapie au moins 1 an après une ICP ou un SCA. Nous avons procédé en 2 temps, d’abord en répertoriant les revues systématiques publiées entre 2019 et 2022 sur ces 2 questions cliniques, puis en effectuant la recherche la plus exhaustive possible pour trouver d’autres essais contrôlés randomisés publiés jusqu’en octobre 2022. Les paramètres qui nous intéressaient étaient les événements cardiovasculaires indésirables majeurs (ECIM), le décès, la thrombose de l’endoprothèse et l’hémorragie majeure. Nous avons estimé les rapports de risques (RR) et les intervalles de confiance (IC) à 95 % à l’aide d’un modèle à effets aléatoires.
D’après 6 essais contrôlés randomisés (n = 10 435), la bithérapie a réduit les hémorragies majeures (RR : 0,62; IC à 95 % : 0,52 à 0,73) et augmenté les thromboses de l’endoprothèse (RR : 1,55; IC à 95 % : 1,02 à 2,36), comparativement à la trithérapie après une ICP ou un SCA ayant fait l’objet d’une prise en charge médicale, tandis qu’aucune différence significative n’a été observée quant aux ECIM et aux décès. Dans 2 essais contrôlés randomisés (n = 2 905), un anticoagulant oral en monothérapie a réduit les hémorragies majeures (RR : 0,66; IC à 95 % : 0,49 à 0,91) comparativement à la bithérapie chez des patients présentant une FA après une ICP ou un SCA plus lointain, sans différence significative quant aux ECIM et aux décès.
Chez les patients présentant une FA et une coronaropathie, l’utilisation d’un traitement antithrombotique moins agressif (bithérapie après un ICP ou un SCA, et anticoagulant oral en monothérapie après une ICP ou un SCA plus lointain) réduit les hémorragies majeures, mais s’accompagne d’une augmentation des thromboses de l’endoprothèse en cas d’ICP récente. Ces résultats plaident en faveur d’une stratégie antithrombotique minimaliste, mais personnalisée chez ces patients.
Research Question: Do external auditors in the United Arab Emirates (UAE) perceive the ease of use and usefulness of Machine Learning (ML)?
Motivation: This study aims to investigate external ...auditors' perceptions of the ease of use and usefulness of Machine Learning in auditing in the UAE. In addition, the study intends to examine the difference in perceived ease of use of Machine Learning between local and international audit companies in the UAE.
Data: Data for this study were gathered from 63 external auditors working for local and global audit firms in the UAE. The study's population comprises external auditors from national and international audit companies in UAE.
Tool: The questionnaire was deployed through an online survey tool.
Findings: The results have shown that the findings do not support the idea that there is a different perception of the Perceived Ease of Use of Machine Learning in auditing between local and international audit firms. According to the conclusions of this study, external auditors have a restricted perception of the simplicity of use and utility of Machine Learning.
Practical implications: The importance of the findings of such research stems from the lack of research evidence on the perceived ease of use and usefulness of Machine Learning in external auditing in the UAE. As a result, this paper provides new empirical evidence by assessing external auditors' assessments of the usage of Machine Learning in the UAE.
Background
Soluble vascular cell adhesion molecule‐1 (sVCAM‐1) is a biomarker of endothelial activation and inflammation. There is still controversy as to whether it can predict clinical outcome ...after ST‐elevation myocardial infarction (STEMI). Our aim was to assess the sVCAM‐1 kinetics and to evaluate its prognostic predictive value.
Method
We prospectively enrolled 251 consecutive STEMI patients who underwent coronary revascularization in our university hospital. Blood samples were collected at admission, 4, 24, 48 h and 1 month after admission. sVCAM‐1 serum level was assessed using ELISA assay. All patients had cardiac magnetic resonance imaging at 1‐month for infarct size (IS) and left ventricular ejection fraction (LVEF) assessment. Clinical outcomes were recorded over 12 months after STEMI.
Results
sVCAM‐1 levels significantly increased from admission up to 1 month and were significantly correlated with IS, LVEF, and LV end‐systolic and diastolic volume. (H48 area under curve (AUC) ≥ H48 median) were associated with an increased risk of adverse clinical events during the 12‐month follow‐up period with a hazard ratio (HR) = 2.6 (95% confidence interval CI of ratio = 1.2–5.6, p = .02). The ability of H48 AUC for sVCAM‐1 to discriminate between patients with or without the composite endpoint was evaluated using receiver operating characteristics with an AUC at 0.67 (0.57–0.78, p = .004). This ability was significantly superior to H48 AUC creatine kinase (p = .03).
Conclusions
In STEMI patients, high sVCAM‐1 levels are associated with a poor clinical outcome. sVCAM‐1 is an early postmyocardial infarction biomarker and might be an interesting target for the development of future therapeutic strategies.
A graphical presentation summarizing the putative key role of sVCAM‐1 after ST‐elevation segment MI. MI: myocardial infarction, MMP: matrix metalloproteinase, oxLDL: Oxidized Low‐Density Lipoprotein, VCAM‐1: vascular cell adhesion molecule 1.
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