Recruitment of the coronary collateral circulation is frequently observed during ST elevation myocardial infarction (STEMI) and is of uncertain significance. The aim of this study was to identify and ...determine the predictors and prognostic implications of the presence of robust collaterals during STEMI. All patients presenting to a large tertiary centre with a STEMI undergoing percutaneous coronary intervention from 2010 to 2018 were reviewed. Patients with poor collateral recruitment were defined as those with Rentrop grade 0 or 1 collaterals, whilst patients with robust collateral recruitment were defined as Rentrop grade 2 or 3. A total of 1,625 patients were included in the study, with 1,280 (78.8%) patients having poor collateral recruitment and 345 patients (21.2%) having robust collateral recruitment. Patients with robust collaterals were younger (63.1 vs 65.1 years, p < 0.05), had a longer ischemic time (628.5 minutes vs 433.1 minutes, p < 0.0001), and more likely to have a chronic total occlusion of a noninfarct related artery (10.4% vs 5.3%, p < 0.001). The presence of robust collaterals was associated with higher rates of normal or mildly impaired left ventricular function (83.5% vs 63.2%, p < 0.0001) and lower in-hospital mortality (2.1% vs 7.6%, p < 0.0001). After correcting for left ventricular function, collateral recruitment was not an independent predictor of mortality. In conclusion, in patients presenting with STEMI, the presence of robust coronary collaterals appears to be associated with improved left ventricular function. Further research is required to identify mechanisms of collateral maturation and recruitment.
Aims Identification and management of the Standard Modifiable Cardiovascular Risk Factors (SMuRFs; hypercholesterolaemia, hypertension, diabetes and smoking) has substantially improved cardiovascular ...disease outcomes. However, cardiovascular disease remains the leading cause of death worldwide. Suspecting an evolving pattern of risk factor profiles in the ST elevation myocardial infarction (STEMI) population with the improvements in primary care, we hypothesized that the proportion of 'SMuRFless' STEMI patients may have increased. Methods/results We performed a single centre retrospective study of consecutive STEMI patients presenting from January 2006 to December 2014. Over the study period 132/695 (25%) STEMI patients had 0 SMuRFs, a proportion that did not significantly change with age, gender or family history. The proportion of STEMI patients who were SMuRFless in 2006 was 11%, which increased to 27% by 2014 (odds ratio 1.12 per year, 95% confidence interval: 1.04-1.22). The proportion of patients with hypercholesterolaemia decreased (odds ratio 0.92, 95% confidence interval 0.86-0.98), as did the proportion of current smokers (odds ratio 0.93, 95% confidence interval 0.86-0.99), with no significant change in the proportion of patients with diabetes and hypertension. SMuRF status was not associated with extent of coronary disease; in-hospital outcomes, or discharge prescribing patterns. Conclusion The proportion of STEMI patients with STEMI poorly explained by SMuRFs is high, and is significantly increasing. This highlights the need for bold approaches to discover new mechanisms and markers for early identification of these patients, as well as to understand the outcomes and develop new targeted therapies.
Mechanosensitive hair cells in the cochlea are responsible for hearing but are vulnerable to damage by genetic mutations and environmental insults. The paucity of human cochlear tissues makes it ...difficult to study cochlear hair cells. Organoids offer a compelling platform to study scarce tissues in vitro; however, derivation of cochlear cell types has proven non-trivial. Here, using 3D cultures of human pluripotent stem cells, we sought to replicate key differentiation cues of cochlear specification. We found that timed modulations of Sonic Hedgehog and WNT signaling promote ventral gene expression in otic progenitors. Ventralized otic progenitors subsequently give rise to elaborately patterned epithelia containing hair cells with morphology, marker expression, and functional properties consistent with both outer and inner hair cells in the cochlea. These results suggest that early morphogenic cues are sufficient to drive cochlear induction and establish an unprecedented system to model the human auditory organ.
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•Timed modulations of SHH and WNT ventralize hPSC-derived inner ear organoids•Cochlear organoids exhibit highly differential expression of GATA3 and NR2F1•Derived hair cells exhibit cochlear-like structural and functional properties•Cochlear organoids give rise to both inner and outer hair cell-like cells
Moore and colleagues present a protocol for generating cochlear organoids from human PSCs by treating otic progenitors with ventralization signals. Derived hair cells in cochlear organoids exhibit molecular, structural, and functional features of cochlear hair cells, and serve as a model to study how sound-sensing hair cells in humans develop.
Abstract Background The Sgarbossa score has been used to identify acute myocardial infarction on ECG in the presence of LBBB but has relied on elevated CK-MB for validation rather than angiographic ...evidence of vessel occlusion. Methods We determined (a) the presence or absence of Sgarbossa criteria with concordant (S-con) or discordant (S-dis) ST changes, (b) the presence of acute coronary occlusion or likely recent occlusion on angiography and (c) the biochemical evidence of myocardial infarction (Troponin T > 0.10 μg/L, Troponin I > 1.0 μg/L) in patients field-triaged with suspected AMI and LBBB. Results Between April 2004 and March 2009, 102 patients had field ECGs transmitted by paramedics for triage — 8 with S-con, 26 with S-dis and 68 with LBBB alone. Acute coronary occlusion was present in 8/8 with S-con but none of the S-dis or LBBB alone patients, and in all 8 S-con patients reperfusion resulted in resolution of S-con changes. Likely culprit lesions with TIMI 3 flow were found in 3 S-dis patients but stenting did not result in resolution of S-dis. LBBB did not resolve in any patient. Troponin was elevated in 26 patients — 11 with occlusion or likely culprit lesions, 15 with non-ischaemic causes. Conclusions In the absence of S-con, LBBB is not associated with acute coronary occlusion and should not be used as criteria for reperfusion therapy in myocardial infarction.
Abstract Purpose The ‘smoker's paradox’ refers to the observation of favorable prognosis in current smokers following an acute myocardial infarction (AMI). Initial positive findings were in the era ...of fibrinolysis, with more contemporary studies finding conflicting results. We sought to determine the presence of a ‘smoker's paradox’ in a cohort of ST Elevation Myocardial Infarction (STEMI) patients identified via field triage, treated with primary percutaneous coronary intervention (pPCI). Methods This was a single center retrospective cohort study identifying consecutive STEMI patients presenting for pPCI via field triage. The primary end points were all cause mortality, major adverse cardiac events (MACE), major bleeding, in-hospital cardiac arrest and length of stay (LOS). Results A total of 382 patients were included in the study. Current smokers were more likely to be younger (p < 0.00001), male (p < 0.001) and have fewer comorbidities, including renal impairment (p < 0.01) and a history of AMI (p < 0.05). Current smokers also had a shorter ischemic time (p < 0.05), were less likely to have collateral circulation (p < 0.05), and more likely to have signs of pulmonary edema at presentation (p < 0.05). There was no difference between smoking groups and all cause mortality (p = 0.67), MACE (p = 0.49), major bleeding (p = 0.49) or in-hospital cardiac arrest (p = 0.43). Current smokers had a shorter LOS (p < 0.05). In multivariate analysis smoking status did not correlate with primary outcomes. Conclusion The ‘smoker's paradox’ does not appear to be relevant among STEMI patients undergoing pPCI, identified via field triage. The previously documented ‘smoker's paradox’ may have been an indication of patient characteristics and the historical treatment of STEMI with thrombolysis. Further studies with larger numbers may be warranted.
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