Podcasts about PCI

DESCRIPTION Dan Mathers, Co-Founder, President & CEO of eleven-x, and Melissa McMahon, Parking and Curbspace Manager with the Arlington County Department of Environmental Services discuss Arlington County's one-of-a-kind parking project. Part Two. SPONSORS This episode is brought to you by Parking Today and the Parking Today Podcast Network. Learn more at parkingtoday.com/podcast. This episode is brought to you by Parker Technology, the customer experience solution of choice for the parking industry. Their solution puts a virtual ambassador in every lane, to help parking guests pay and get on their way in under a minute. Learn more at parkertechnology.com/parkingpodcast and subscribe to our podcast “Harder Than It Looks: Parking Uncovered.” This episode is brought to you by Scheidt & Bachman USA. Scheidt & Bachmann USA markets state-of-the-art Parking Solutions and Fare Collection Systems: the most innovative and advanced solutions in the US. Learn more at scheidt-bachmann-usa.com. This episode is brought to you by Breeze: Parking Concepts' digital platform that makes the parking experience a Breeze! For more than 50 years, PCI has been proactively managing parking & transportation operations with unparalleled integrity & service. Learn more at parkingconcepts.com. This episode is brought to you by Parkmobile. Parkmobile, a part of EasyPark Group, is the leading provider of smart parking and mobility solutions in North America, using a contactless approach to help millions of people easily find, reserve, and pay for parking on their mobile devices. Learn more about parkmobile.io. This episode is brought to you by Parkalytics. Parkalytics will take drone images of parking lots and/or on-street parking for a given time period and then upload those images into their parkalytics software. Within a matter of seconds, it will provide you parking counts, turnover studies, utilization studies, you name it. You can now wow your clients or supervisors by having a complete snapshot of the parking usage for a fraction of the price of a traditional parking study. Learn more at parkalytics.com. WEBSITES AND RESOURCES https://www.parkingcast.com/ https://parkingtoday.com/podcast/ www.parkertechnology.com/parkingpodcast scheidt-bachmann-usa.com parkingconcepts.com parkmobile.io parkalytics.com https://www.arlingtonva.us/Government/Programs/Transportation/Parking/Performance-Parking-Pilot https://eleven-x.com/ MERCH Check out some of our awesome parking themed t-shirts and other merch at parkingcast.com/swag. MUSEUM Check out some of our artifacts from the world's first parking museum at parkingcast.com/museum.

Episode Topic: Ruston Miles of Bluefin joins PayPod to unravel the real story behind payment data security. From debunking myths around chip card protection to highlighting the need for encryption at the point of interaction, Ruston shares critical insights into why businesses must adopt P2P encryption and tokenization to stay ahead of evolving threats. Lessons You'll Learn: How to distinguish fraud prevention from data security, the necessity of protecting data at the entry point, why chips don't equal encryption, and how upcoming technologies like quantum computing and AI are reshaping the threat landscape. About Our Guest: Ruston Miles is the Founder and Chief Strategy Officer at Bluefin, a payment security company that pioneered PCI-validated point-to-point encryption. With decades of experience in cybersecurity, Ruston has been instrumental in setting encryption standards adopted by Visa, Mastercard, and global universities. He's also a strong advocate for tokenization, quantum-resistant encryption, and secure digital wallets. Topics Covered: The difference between fraud and data breaches   How P2P encryption protects data before it can be stolen   Why EMV chips give a false sense of security   Storing tokens instead of real card numbers   Security challenges in higher education and enterprise   Quantum computing's potential threat to public key encryption

In this industry-sponsored episode, host Praveen Ranganath, MD is joined by Yader Sandoval, MD and Jonathon Leipsic, MD, MSCCT, the chair and co-chair of the recently published inter-society roundtable document on CCTA for PCI planning. Conversation topics include the origin of this expert roundtable, the benefits of and evidence supporting CCTA for PCI planning, a deep-dive into heavily calcified and bifurcation lesion planning, and insights on how to tackle current barriers to adoption. Coronary Computed Tomography Angiography to Guide Percutaneous Coronary Intervention: Expert Opinion from a SCAI/SCCT RoundtableThis episode is sponsored by Heartflow. References to a specific product, process, or service by speakers in this podcast episode do not constitute or imply an endorsement by the Society of Cardiovascular Computed Tomography. The views and opinions expressed in do not necessarily reflect those of the Society of Cardiovascular Computed Tomography.

In the latest JACC offering from EuroPCR, JACC Associate Editor Celina M. Yong, MD, FACC, interviews Dr. Ashkan Eftekhari, PhD, to discuss insights into his study, Biolimus-Eluting Biomatrix Stent Versus a Dual-Therapy Sirolimus-Eluting Stent in PCI: SORT OUT XI Randomized Trial. The biolimus A9-eluting BioMatrix Alpha stent (BES), has not been compared with another contemporary drug eluting stent. This study compared one-year target lesion failure (TLF) in BES versus the dual-therapy sirolimus-eluting Combo stent (DTS) in an all-comer population undergoing PCI. A total of 3,136 patients were randomized 1:1 to either BES or DTS. The primary result showed that BES was non-inferior to DTS. Additionally, there was a significantly higher rate of definite stent thrombosis in the BES arm. In conclusion, BES was non-inferior to DTS at one-year follow-up with respect to the primary endpoint, TLF.

Marcela Belleza e Raphael Coelho convidam Matheus Rezende, residente do último ano de Cardiologia - Incor, para conversar sobre manejo de doença coronariana crônica em tres tópicos:- Como realizar a investigação inicial?- Como fazer a terapia medicamentosa inicial?- O que fazer com o paciente que não melhora?Referências: 1. Vrints C, Andreotti F, Koskinas KC, et al. 2024 ESC Guidelines for the management of chronic coronary syndromes [published correction appears in Eur Heart J. 2025 Feb 21:ehaf079. doi: 10.1093/eurheartj/ehaf079.]. Eur Heart J. 2024;45(36):3415-3537. doi:10.1093/eurheartj/ehae1772. Virani, Salim S et al. “2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines.” Circulation vol. 148,9 (2023): e9-e119. doi:10.1161/CIR.00000000000011683. Montone RA, Rinaldi R, Niccoli G, et al. Optimizing Management of Stable Angina: A Patient-Centered Approach Integrating Revascularization, Medical Therapy, and Lifestyle Interventions. J Am Coll Cardiol. 2024;84(8):744-760. doi:10.1016/j.jacc.2024.06.0154. Mortensen MB, Dzaye O, Steffensen FH, et al. Impact of Plaque Burden Versus Stenosis on Ischemic Events in Patients With Coronary Atherosclerosis. J Am Coll Cardiol. 2020;76(24):2803-2813. doi:10.1016/j.jacc.2020.10.0215. Doenst T, Haverich A, Serruys P, et al. PCI and CABG for Treating Stable Coronary Artery Disease: JACC Review Topic of the Week. J Am Coll Cardiol. 2019;73(8):964-976. doi:10.1016/j.jacc.2018.11.0536. Maron DJ, Hochman JS, Reynolds HR, et al. Initial Invasive or Conservative Strategy for Stable Coronary Disease. N Engl J Med. 2020;382(15):1395-1407. doi:10.1056/NEJMoa19159227. Rajkumar CA, Foley MJ, Ahmed-Jushuf F, et al. A Placebo-Controlled Trial of Percutaneous Coronary Intervention for Stable Angina. N Engl J Med. 2023;389(25):2319-2330. doi:10.1056/NEJMoa23106108. Eikelboom JW, Connolly SJ, Bosch J, et al. Rivaroxaban with or without Aspirin in Stable Cardiovascular Disease. N Engl J Med. 2017;377(14):1319-1330. doi:10.1056/NEJMoa17091189. Howlett JG, Stebbins A, Petrie MC, et al. CABG Improves Outcomes in Patients With Ischemic Cardiomyopathy: 10-Year Follow-Up of the STICH Trial. JACC Heart Fail. 2019;7(10):878-887. doi:10.1016/j.jchf.2019.04.01810. Nidorf SM, Fiolet ATL, Mosterd A, et al. Colchicine in Patients with Chronic Coronary Disease. N Engl J Med. 2020;383(19):1838-1847. doi:10.1056/NEJMoa202137211. Boden WE, O'Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356(15):1503-1516. doi:10.1056/NEJMoa07082912. Ford TJ, Stanley B, Good R, et al. Stratified Medical Therapy Using Invasive Coronary Function Testing in Angina: The CorMicA Trial. J Am Coll Cardiol. 2018;72(23 Pt A):2841-2855. doi:10.1016/j.jacc.2018.09.00613. Carvalho, Tales de et al. “Brazilian Cardiovascular Rehabilitation Guideline - 2020.” “Diretriz Brasileira de Reabilitação Cardiovascular – 2020.” Arquivos brasileiros de cardiologia vol. 114,5 (2020): 943-987. doi:10.36660/abc.20200407

DESCRIPTION Dan Mathers, Co-Founder, President & CEO of eleven-x, and Melissa McMahon, Parking and Curbspace Manager with the Arlington County Department of Environmental Services discuss Arlington County's one-of-a-kind parking project. SPONSORS This episode is brought to you by Parking Today and the Parking Today Podcast Network. Learn more at parkingtoday.com/podcast. This episode is brought to you by Parker Technology, the customer experience solution of choice for the parking industry. Their solution puts a virtual ambassador in every lane, to help parking guests pay and get on their way in under a minute. Learn more at parkertechnology.com/parkingpodcast and subscribe to our podcast “Harder Than It Looks: Parking Uncovered.” This episode is brought to you by Scheidt & Bachman USA. Scheidt & Bachmann USA markets state-of-the-art Parking Solutions and Fare Collection Systems: the most innovative and advanced solutions in the US. Learn more at scheidt-bachmann-usa.com. This episode is brought to you by Breeze: Parking Concepts' digital platform that makes the parking experience a Breeze! For more than 50 years, PCI has been proactively managing parking & transportation operations with unparalleled integrity & service. Learn more at parkingconcepts.com. This episode is brought to you by Parkmobile. Parkmobile, a part of EasyPark Group, is the leading provider of smart parking and mobility solutions in North America, using a contactless approach to help millions of people easily find, reserve, and pay for parking on their mobile devices. Learn more about parkmobile.io. This episode is brought to you by Parkalytics. Parkalytics will take drone images of parking lots and/or on-street parking for a given time period and then upload those images into their parkalytics software. Within a matter of seconds, it will provide you parking counts, turnover studies, utilization studies, you name it. You can now wow your clients or supervisors by having a complete snapshot of the parking usage for a fraction of the price of a traditional parking study. Learn more at parkalytics.com. WEBSITES AND RESOURCES https://www.parkingcast.com/ https://parkingtoday.com/podcast/ www.parkertechnology.com/parkingpodcast scheidt-bachmann-usa.com parkingconcepts.com parkmobile.io parkalytics.com https://www.arlingtonva.us/Government/Programs/Transportation/Parking/Performance-Parking-Pilot https://eleven-x.com/ MERCH Check out some of our awesome parking themed t-shirts and other merch at parkingcast.com/swag. MUSEUM Check out some of our artifacts from the world's first parking museum at parkingcast.com/museum.

 Dòng chảy kinh tế 09/05/2025 có những nội dung sau:- Chỉ số Năng lực cạnh tranh cấp tỉnh PCI - vai trò và yêu cầu trong bối cảnh mới.- Quỹ thúc đẩy sử dụng năng lượng tiết kiệm và hiệu quả, "đòn bẩy" hỗ trợ doanh nghiệp đầu tư công nghệ và chuyển đổi xanh.- Dịch vụ công trực tuyến của kho bạc hỗ trợ tích cực các đơn vị sử dụng ngân sách ở địa phương miền núi.

Key Takeaways:AI can be viewed as a necessity for growth to drive both cost savings and revenue growth.Establishing a strong governance framework is crucial for managing risks associated with AI, such as data breaches and compliance with regulations like HIPAA and PCI.AI can be used both reactively to address immediate pain points and proactively to predict and optimize future business operations.While speed and scale are important, startups must ensure they do not compromise on compliance and governance, which are vital for sustainable growth.Developing an AI use policy is a best practice to guide internal and external applications of AI, ensuring responsible and effective usage.

La pista neofascista alla base della riapertura dell'inchiesta sull'omicidio di Fausto e Iaio. Non è cosa semplice riaprire un'inchiesta 47 anni dopo un duplice omicidio politico come quello di Fausto Tinelli e Lorenzo Iannucci, uccisi a Milano, il 18 marzo 1978, in pieno rapimento di Aldo Moro. I ragazzi vennero attesi in via Mancinelli, nel quartiere Casoretto, da tre killer provenienti da Roma, due con l'impermeabile chiaro e uno con il giubbotto marrone. Uno di loro sparò contro i due ragazzi di sinistra otto colpi di pistola utilizzando la tecnica del sacchetto di plastica per trattenere i bossoli. Le vie di fuga percorse, le moto utilizzate, dimostrano che l'agguato era stato preparato con cura da una rete logistica composta da neofascisti milanesi. In una intercettazione ambientale nel Bar Pirata, luogo di raduno di destra, gli investigatori ascoltarono la telefonata di uno che aveva dimenticato nel locale un impermebile bianco. I poliziotti di Roma perquisirono la casa di un noto esponente della destra e vi trovarono fotografie di Fausto e Iaio, oltre a lettere e documenti compromettenti. L'ultima inchiesta. La giustizia parte oggi dove aveva fallito nell'anno 2000, dal decreto della Gup Clementina Forleo che archiviò l'indagine su Massimo Carminati, l'uomo poi coinvolto nell'inchiesta su Mafia capitale, Claudio Bracci e Mario Corsi detto Marione, oggi popolare conduttore sportivo romano. Su questi tre nomi, e su altri non ancora identificati, ripartono i nuovi accertamenti. In particolare saranno comparati due documenti di rivendicazione: quello per l'omicidio di Fausto e Iaio e per l'attentato contro la sezione del Pci del quartiere Balduina a Roma, il 29 maggio 1978, entrambi firmati "Esercito nazionale rivoluzionario-Brigata combattente Franco Anselmi". Verranno verificate vecchie e nuove testimonianze di collaboratori di giustizia dell'estrema destra, analizzati documenti e indumenti sequestrati durante le perquisizioni del 1978, e molto altro ancora, con le tecnologie moderne. E' l'ultima possibilità per scoprire uno dei pochissimi omicidi politici degli anni Settanta rimasti irrisolti sul piano giudiziario, come l'assassinio di Valerio Verbano, avvenuto a Roma, il 22 febbraio 1980. "Il Corsivo" a cura di Daniele Biacchessi non è un editoriale, ma un approfondimento sui fatti di maggiore interesse che i quotidiani spesso non raccontano. Un servizio in punta di penna che analizza con un occhio esperto quell'angolo nascosto delle notizie di politica, economia e cronaca. ___________________________________________________ Ascolta altre produzioni di Giornale Radio sul sito: https://www.giornaleradio.fm oppure scarica la nostra App gratuita: iOS - App Store - https://apple.co/2uW01yA Android - Google Play - http://bit.ly/2vCjiW3 Resta connesso e segui i canali social di Giornale Radio: Facebook: https://www.facebook.com/giornaleradio.fm/ Instagram: https://www.instagram.com/giornale_radio_fm/?hl=it

(This episode originally aired on October 22, 2024.) For years, the best word to describe Medicare Advantage (MA) was “untouchable.” Hugely popular among seniors, profitable for health plans—the hybrid public-private payment model grew to the point that it now covers more seniors than traditional Medicare. But in the past few years, the tide has started to change. And if you've been paying attention in recent months, you'll have seen headlines announcing that payers that are scaling back their MA offerings and providers are exiting MA contracts. The MA market has gone from “untouchable” to “volatile.” The question is: why is this happening, and what does it mean for payers, providers, and seniors moving forward? In this episode, hosts Rachel (Rae) Woods and Abby Burns invite health plan experts Max Hakanson and Chelsea Needham to dissect what is going on in MA and how plans and providers are—or should be—navigating the changing tide. Links: Ep. 203: Value series: Is the future of VBC in specialty care? Zing Health & Strive Health say yes. Ep. 149: Senior Care (Part 1): Specialized primary care for an aging population Ep. 150: Senior Care (Part 2): The rapid growth of Medicare Advantage 3 traits health plans want in a provider partner 4 traits providers want in a health plan partner Around the nation: CMS releases Medicare Advantage Star Ratings Q&A: Cardiologist Navin Kapur discusses the future of complex PCI

In this episode, Dr. Valentin Fuster, provides a concise summary of the May 13, 2025 issue. He discusses four original studies on key cardiovascular topics, including the impact of chronic kidney disease and obesity on heart failure, the role of dobutamine stress echocardiography in predicting PCI outcomes, the effects of empagliflozin on erythropoiesis in heart failure, and the influence of adiposity, insulin resistance, and diabetes in heart failure with preserved ejection fraction. He highlights emerging insights into treatment strategies and ongoing challenges in understanding these complex cardiovascular conditions. Concluding with a separate review on anthracycline cardiotoxicity in cancer patients.

In this podcast, Dr. Valentin Fuster discusses a groundbreaking study from the Orbiter 2 trial, which explores how dobutamine stress echocardiography (DSE) can predict the efficacy of percutaneous coronary intervention (PCI) in relieving angina in patients with stable coronary artery disease. The study reveals that the degree of ischemia, as measured by DSE, is strongly correlated with improvement in symptoms, offering new insights into patient selection for PCI treatment.

In this episode, Dustin Burleson sits down with the powerhouse leadership team behind Rock Dental Brands to answer one of the most pressing questions in modern dentistry and orthodontics: How do I avoid choosing the wrong DSO?You'll hear directly from CEO Kristi Casey, Chief Development Officer Spencer Lunghino, and Co-Founder Dr. Mark Dake as they share a transparent look into the origins, philosophy, and strategic direction of Rock Dental Brands. Together, they bust myths around private equity, clinical autonomy, and growth timelines—and reveal what doctors should really be asking before joining a DSO.If you're a dentist, orthodontist, or specialist considering your next move, this episode is a must-listen. What You'll Learn:The real story behind private equity in dentistry—where the money comes from and how it worksWhy not all DSOs (or equity structures) are created equalHow Rock Dental Brands evolved from a doctor-led support model to a nationally respected DSOThe biggest myths around clinical autonomy, ownership, and growthWhy Rock's equity model is designed to treat doctors fairly—and how that differs from joint venturesHow to reverse-engineer a smart partnership decision using Charlie Munger's “invert and avoid” philosophyWhat questions to ask during DSO due diligence (and how to avoid future regret) Key Quotes:“We were built to be proud of the work we're doing 50 years from now." —Dr. Mark Dake“You're not giving up control of your practice. You're gaining part of 110 practices.” —Kristi Casey Connect with Our Guests:Spencer Lunghino – spencer.lunghino@rockdentalbrands.comrockdentalbrands.com Resources Mentioned:GreyFinch Practice Management SoftwareDentiCon by Planet DDSVistria Group – Private equity partner of Rock Dental Brands Subscribe & Review:If you enjoyed this episode, please leave a review and subscribe to The Burleson Box on Apple Podcasts, Spotify, or wherever you listen. Your support helps us bring powerful conversations like this to more listeners in healthcare leadership. ***The Burleson Box is brought to you by Stax Payments:Save Big on Transaction Fees: Boost Your Bottom Line with Stax Payments.Did you know that your practice can start saving thousands of dollars on your monthly processing costs with our preferred payments partner, Stax? Simplify your practice operations and provide a quality patient experience. Healthcare practices like yours need a way to accept payments simply and securely. That's where Stax comes in.Stax helps you manage your entire payments experience from within one platform. You can safely accept touch-free payments in-person, online, or over the phone, securely store and manage patient information with layered security and Level 1 PCI compliance.
Take advantage of a simpler, more transparent way to process your payments with competitive flat-rate pricing, provided exclusively through Stax. No additional fees or contracts required!Power your practice and get paid faster with simple, safe and secure payment solutions. Have questions? Schedule time to speak with a dedicated payment consultant to learn more.Click Below to Lear More Today:StaxPayments.com/burleson-seminars*** Go Premium: Members get early access, ad-free episodes, hand-edited transcripts, exclusive study guides, special edition books each quarter, powerpoint and keynote presentations and two tickets to Dustin Burleson's Annual Leadership Retreat.http://www.theburlesonbox.com/sign-up Stay Up to Date: Sign up for The Burleson Report, our weekly newsletter that is delivered each Sunday with timeless insight for life and private practice. Sign up here:http://www.theburlesonreport.com Follow Dustin Burleson, DDS, MBA at:http://www.burlesonseminars.com

The goal of CPR is to keep the brain and vital organs perfused until return of spontaneous circulation (ROSC) is achieved.Post-arrest care and recovery are the final two links in the chain of survival.Identification of ROSC during CPR.Initial patient management goals after identifying ROSC.Indications for starting TTM.Monitoring the patient's core temperature.Patients can undergo EEG, CT, MRI, & PCI while receiving TTM.Good luck with your ACLS class!Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/Free Prescription Discount Card - Download your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/savePass ACLS Web Site - Episode archives & other ACLS-related podcasts: https://passacls.com@Pass-ACLS-Podcast on LinkedIn Chapters0:00 Identifying ROSC0:59 Additional ACLS Resources (https://passacls.com)1:05 Save on prescription meds (https://safemeds.vip)1:21 Post Arrest Assessment & Goals3:04 Indications & Initiation of TTM4:02 Two TTM Tips4:50 Share Pass ACLS on LinkedIn

Send us a textDr. Nicole Gensicke, a new vascular surgeon with St. Luke's and Physicians' Clinic of Iowa Vascular Surgery program, joins Dr. Arnold to talk about her background, clinical and personal interests, what led her to PCI and UnityPoint Health and much more.Patients experiencing vein issues may call (319) 368-8346 to schedule an appointment with Dr. Gensicke. This is another episode in a segment on the podcast called "New Clinician Spotlight." In these episodes, Dr. Arnold will sit down with new clinicians at UnityPoint Health - Cedar Rapids and get to know them as a clinician and as a person.Do you have a question about a trending medical topic? Ask Dr. Arnold! Submit your question and it may be answered by Dr. Arnold on the podcast! Submit your questions at: https://www.unitypoint.org/cedarrapids/submit-a-question-for-the-mailbag.aspxIf you have a topic you'd like Dr. Arnold to discuss with a guest on the podcast, shoot us an email at stlukescr@unitypoint.org.

DESCRIPTION Vanessa Cummings, Founder of Ms. V Consulting, discusses customer service, IPMI and college basketball. SPONSORS This episode is brought to you by Parking Today and the Parking Today Podcast Network. Learn more at parkingtoday.com/podcast. This episode is brought to you by Parker Technology, the customer experience solution of choice for the parking industry. Their solution puts a virtual ambassador in every lane, to help parking guests pay and get on their way in under a minute. Learn more at parkertechnology.com/parkingpodcast and subscribe to our podcast “Harder Than It Looks: Parking Uncovered.” This episode is brought to you by Scheidt & Bachman USA. Scheidt & Bachmann USA markets state-of-the-art Parking Solutions and Fare Collection Systems: the most innovative and advanced solutions in the US. Learn more at scheidt-bachmann-usa.com. This episode is brought to you by Breeze: Parking Concepts' digital platform that makes the parking experience a Breeze! For more than 50 years, PCI has been proactively managing parking & transportation operations with unparalleled integrity & service. Learn more at parkingconcepts.com. This episode is brought to you by Parkmobile. Parkmobile, a part of EasyPark Group, is the leading provider of smart parking and mobility solutions in North America, using a contactless approach to help millions of people easily find, reserve, and pay for parking on their mobile devices. Learn more about parkmobile.io. This episode is brought to you by Parkalytics. Parkalytics will take drone images of parking lots and/or on-street parking for a given time period and then upload those images into their parkalytics software. Within a matter of seconds, it will provide you parking counts, turnover studies, utilization studies, you name it. You can now wow your clients or supervisors by having a complete snapshot of the parking usage for a fraction of the price of a traditional parking study. Learn more at parkalytics.com. WEBSITES AND RESOURCES https://www.parkingcast.com/ https://parkingtoday.com/podcast/ www.parkertechnology.com/parkingpodcast scheidt-bachmann-usa.com parkingconcepts.com parkmobile.io parkalytics.com https://login.parking-mobility.org/contacts/vanessa-r-cummings https://www.linkedin.com/in/vanessa-r-cummings-m-div-ptmp-6a80054/ MERCH Check out some of our awesome parking themed t-shirts and other merch at parkingcast.com/swag. MUSEUM Check out some of our artifacts from the world's first parking museum at parkingcast.com/museum.

Το ACC 2025 μας έφερε νέες κλινικές μελέτες και κάθε μία είχε τη δική της ιστορία να πει:WARRIOR: Η καρδιαγγειακή πρόληψη στις γυναίκες εξελίσσεται. Πως θα χειριζόσασταν γυναίκες με μη αποφρακτική στεφανιαία νόσο (INOCA);RIVAWAR: Rivaroxaban εναντίον warfarin σε θρόμβο αριστερής κοιλίας. SOUL: Η εξέλιξη της σεμαγλουτίδης σε απο του στόματος μορφή υπόσχεται καλά αποτελέσματαSTRIDE: Ποιος ο ρόλος της σεμαγλουτίδης σε ασθενείς με διαβήτη και περιφερική αγγειοπάθεια;DAPA-TAVI: Η νταπαγλιφλοζίνη μετά από TAVI δείχνει καρδιοπροστατευτικά οφέλη σε ασθενείς με καρδιακή ανεπάρκεια ZENITH: Sotatercept σε σοβαρή πνευμονική αρτηριακή υπέρταση, μια ακόμα νίκη.FAME 3: Όταν η φυσιολογία μετράει – η FFR-guided PCI vs CABG σε πολυαγγειακή νόσο.SINGLE SHOT CHAMPION: PFA vs cryoballoon σε ασθενείς με παροξυσμική κολπική μαρμαρυγή, ποιο είναι το μέλλον;

N Engl J Med 2017;377:2419-2432Background: A small fraction of patients with acute myocardial infarction (5-10%) have cardiogenic shock. These patients have a high baseline mortality. Early revascularization had been established as better than initial stabilization with medical therapy. Many patients with cardiogenic shock due to acute myocardial infarction (AMI) have multivessel disease. The question arises about whether to do culprit-only percutaneous coronary intervention (PCI) or more complete PCI at the time of the initial intervention.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.The Culprit Lesion Only PCI versus Multivessel PCI in Cardiogenic Shock (CULPRIT-SHOCK) trial was designed to test the hypothesis that PCI of the culprit lesion only, with the option of staged revascularization of nonculprit lesions, would result in better clinical outcomes than immediate multivessel PCI among patients who have multivessel coronary artery disease and acute myocardial infarction with cardiogenic shock.Patients: The trial enrolled 706 patients with acute myocardial infarction (ST-segment elevation or non-ST-segment elevation) complicated by cardiogenic shock who had multivessel coronary artery disease. Cardiogenic shock was defined as SBP < 90 mmHg for more than 30 minutes or requiring pressors, clinical signs of pulmonary congestion, and signs of organ hypoperfusion (altered mental status, cold/clammy skin, oliguria, or lactate > 2 mmol/L).Exclusion criteria were extensive and designed to exclude patients with extremely poor prognosis: prolonged resuscitation, no intrinsic heart action, fixed dilated pupils, an indication for urgent CABG, a mechanical cause of shock, age > 90 years, massive pulmonary embolism, or severe renal insufficiency at baseline.Baseline Characteristics: The median age was 70 years, and approximately 75% were male. About 63% of patients had three-vessel disease. More than half the patients had ST-segment elevation myocardial infarction (about 62%), and anterior ST-segment elevation MI accounted for approximately 54% of these cases. About 53% of patients required resuscitation before randomization. The median left ventricular ejection fraction was between 30-33%.Procedures: In the culprit-lesion-only PCI group, only the culprit lesion was treated during the initial procedure, with staged revascularization encouraged based on residual ischemic lesions. In the multivessel PCI group, PCI of all major coronary arteries with >70% stenosis was performed, including attempts to recanalize chronic total occlusions. Crossover from the culprit-lesion-only PCI group to the multivessel PCI group occurred in 12.5% of patients, while crossover in the opposite direction happened in 9.4% of patients. The overall dose of contrast material was significantly higher and the duration of fluoroscopy significantly longer in the multivessel PCI group. Other interventional therapeutic measures were allowed, independent of the assigned treatment strategy.Endpoints: The primary endpoint was a composite of death from any cause or severe renal failure leading to renal-replacement therapy within 30 days after randomization. Secondary endpoints included the individual components of the primary endpoint, recurrent myocardial infarction, rehospitalization for heart failure, repeat revascularization, time to hemodynamic stabilization, catecholamine therapy duration, ICU stay duration, and measurements of renal and myocardial injury. Safety end points included bleeding, which was defined as type 2, 3, or 5 on the Bleeding Academic Research Consortium (BARC) scale.Trialists estimated an event rate of the composite primary endpoint of 38% in the culprit-only group vs 50% in the complete group. Using a global type I error level of 0.05, the authors calculated that a sample of 684 patients would give the trial 80% power to rule out the null hypothesis of no difference between the two treatment groups in the event rate for the primary end point.Results: At 30 days, the composite primary endpoint occurred in 45.9% of patients in the culprit-lesion-only PCI group versus 55.4% in the multivessel PCI group (relative risk, 0.83; 95% CI, 0.71 to 0.96; P=0.01). Death occurred in 43.3% of the culprit-lesion-only PCI group versus 51.6% of the multivessel PCI group (relative risk, 0.84; 95% CI, 0.72 to 0.98; P=0.03). The rate of renal-replacement therapy was 11.6% in the culprit-lesion-only PCI group and 16.4% in the multivessel PCI group (relative risk, 0.71; 95% CI, 0.49 to 1.03; P=0.07).Rates of recurrent myocardial infarction, rehospitalization for heart failure, bleeding, and stroke did not differ significantly between groups. Subgroup analyses showed consistent results across all prespecified subgroups. The time to hemodynamic stabilization, the use of catecholamine therapy and the duration of such therapy, the duration of the ICU stay, and the use of mechanical ventilation and the duration of such therapy also did not differ significantly between the two groups.Conclusion: In patients with myocardial infarction and cardiogenic shock, culprit-only PCI was superior to multivessel PCI. Both components of the primary endpoint, death and severe renal failure were lower in the culprit-only arm. The authors and editorialists speculate why these findings contrast with trials in hemodynamically stable myocardial infarction patients, where early multivessel PCI showed benefit over culprit-only PCI.If you accept the thesis that multi-vessel PCI was superior to culprit-only PCI in stable AMI patients, the likely reason for the disparate results are that patients with cardiogenic shock differ substantially from stable patients. The sicker patients with cardiogenic shock benefit from a less-is-more approach where culprit-only PCI reduces treatment harm relative to multivessel PCI.We at CardiologyTrials, however, find the evidence for complete revascularization in stable AMI patients less than clear. The COMPLETE trial found benefit from multivessel PCI over culprit-only, but both composite endpoints were driven largely by non-fatal MI. CV death was not substantially different. The difference in MI could have been related to excluding procedure-related MI.What's more, the FULL-REVASC trial, which also compared culprit-only and multivessel PCI, failed to replicate the COMPLETE trial results. In FULL-REVASC the rates of the composite primary outcome of death, MI or unplanned revascularization were not significantly different. Sadly, FULL-REVASC was stopped early when COMPLETE results were published, which led to a possible loss of power.It's possible, likely even, that the null results of CULPRIT-SHOCK are not really that disparate from prior trials in patients with more stable AMI.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

ST. PETERSBURG, FL - April 2025 - As the cloud communications sector embraces artificial intelligence (AI), BroadSource is stepping forward with a practical message for resellers: You can profit from AI — if you first help your customers solve data privacy challenges. Speaking with Technology Reseller News at the Cloud Communications Alliance's Cloud Connections 2025 event, Bill Placke, President of Americas for BroadSource, outlined how the company's SecureCall platform helps overcome a critical barrier to AI adoption. “Legal and compliance concerns around collecting personal data are slowing AI deployment,” said Placke. “Our SecureCall solution removes sensitive personal information like credit card or Social Security numbers at the time of collection — enabling safe and compliant AI use.” BroadSource's SecureCall product, which earned Cisco's Top 3 Global Innovation Award, enables secure data input during phone-based customer interactions. Customers input card details or other personal information directly, while the merchant remains on the call without hearing sensitive tones. Data is transmitted securely for processing, bypassing the merchant's internal systems and eliminating storage liability. With new PCI DSS 4.0 standards taking effect and global regulations such as GDPR and CCPA evolving, businesses face growing risks for non-compliance. Placke noted that SecureCall removes this burden from the enterprise. “Companies can rely on BroadSource's own PCI certification for compliance,” he said. “That means fewer headaches for IT and finance leaders — and real value for the reseller who delivers the solution.” BroadSource is expanding SecureCall's capabilities under the SecurePII brand to address broader categories of personal data. The goal is to create a foundation of data minimization, enabling enterprises to leverage AI and LLMs (large language models) without running afoul of data protection laws. Placke likens the opportunity to the 1840s Gold Rush: “AI is the gold. BroadSource is the pickaxe and blue jeans — the tools every prospector needs to get started.” For resellers navigating the fast-moving AI landscape, Placke advises aligning with customer priorities. “Cybersecurity is the top concern for IT leaders,” he said. “Look at breach points like passwords and explore solutions that offer more secure alternatives. When you bring customers practical AI tools with compliance built in, you're not just selling a service — you're building trust.” BroadSource also offers EMU CAPP, a behavioral analytics product that uses AI to monitor user behavior on BroadWorks platforms and detect anomalies, helping prevent toll fraud. “Resellers should lean in,” Placke concluded. “There's a real opportunity to lead by helping your customers adopt AI safely.” For more information, visit broadsource.com or secure-pii.com.

Mirza Umair Khalid, MD, social media editor of JACC: Cardiovascular Interventions, and William F. Fearon, MD, FACC, discuss analysis from FAME III trial comparing outcomes of CABG vs FFR-guided multivessel PCI for patients in ACS versus CCS.

In this episode, Tyler and Brad discuss DMARC and how the latest version of the PCI framework requires phishing protection. You'll also learn about DMARC, DKIM, and SPF and how to elevate them to help protect your organization from attacks like Business Email Compromise (BEC).Blog: https://offsec.blog/Youtube: https://www.youtube.com/@cyberthreatpovTwitter: https://x.com/cyberthreatpov Spencer's Twitter: https://x.com/techspenceSpencer's LinkedIn: https://linkedin.com/in/SpencerAlessi Work with Us: https://securit360.com

DESCRIPTION Joe Galeas, CEO of Parking Solutions and Graham Haldeman, Vice President of Sales of Scheidt and Bachmann discuss culture, data and technology. SPONSORS This episode is brought to you by Parking Today and the Parking Today Podcast Network. Learn more at parkingtoday.com/podcast. This episode is brought to you by Parker Technology, the customer experience solution of choice for the parking industry. Their solution puts a virtual ambassador in every lane, to help parking guests pay and get on their way in under a minute. Learn more at parkertechnology.com/parkingpodcast and subscribe to our podcast “Harder Than It Looks: Parking Uncovered.” This episode is brought to you by Scheidt & Bachman USA. Scheidt & Bachmann USA markets state-of-the-art Parking Solutions and Fare Collection Systems: the most innovative and advanced solutions in the US. Learn more at scheidt-bachmann-usa.com. This episode is brought to you by Breeze: Parking Concepts' digital platform that makes the parking experience a Breeze! For more than 50 years, PCI has been proactively managing parking & transportation operations with unparalleled integrity & service. Learn more at parkingconcepts.com. This episode is brought to you by Parkmobile. Parkmobile, a part of EasyPark Group, is the leading provider of smart parking and mobility solutions in North America, using a contactless approach to help millions of people easily find, reserve, and pay for parking on their mobile devices. Learn more about parkmobile.io. This episode is brought to you by Parkalytics. Parkalytics will take drone images of parking lots and/or on-street parking for a given time period and then upload those images into their parkalytics software. Within a matter of seconds, it will provide you parking counts, turnover studies, utilization studies, you name it. You can now wow your clients or supervisors by having a complete snapshot of the parking usage for a fraction of the price of a traditional parking study. Learn more at parkalytics.com. WEBSITES AND RESOURCES https://www.parkingcast.com/ https://parkingtoday.com/podcast/ www.parkertechnology.com/parkingpodcast scheidt-bachmann-usa.com parkingconcepts.com parkmobile.io parkalytics.com MERCH Check out some of our awesome parking themed t-shirts and other merch at parkingcast.com/swag. MUSEUM Check out some of our artifacts from the world's first parking museum at parkingcast.com/museum.

Channel Partners Conference & Expo 2025 | Las Vegas "Be the trusted business advisor." That's the message from Ryan Henley, Chief Revenue Officer at NUSO, who joined Technology Reseller News publisher Doug Green live on the opening day of the Channel Partners 2025 expo. For years, Henley noted, MSPs have been encouraged to be “trusted technology advisors.” But at this year's show, NUSO is pushing for a shift—one that positions channel partners not just as tech experts, but as core strategic partners who help customers grow and protect their businesses. “It's not about selling software—it's about elevating the business,” said Henley. “Whether it's customer experience or compliance, we can help our partners deliver real business outcomes.” Helping MSPs Go Beyond the Stack NUSO offers a fully integrated service platform that includes: Omnichannel contact center solutions for both enterprise and informal CX environments Compliance tools to support HIPAA, PCI, and GDPR requirements A UCaaS foundation powered by NUSO's own telephony network What sets NUSO apart is ownership. All platform elements are built and operated in-house, offering MSPs a single partner with end-to-end accountability. “You've got one throat to choke, or one back to pat,” Henley quipped. “It simplifies support and strengthens the value MSPs can offer.” A Channel-Only Strategy As a 100% channel-focused company, NUSO is using its presence at Channel Partners to reinforce its commitment to resellers and service providers across North America and beyond. “We're here to help partners break out of the technology-only mindset,” said Henley. “By enabling them to deliver customer experience, compliance, and communications—under one roof—we're helping them transform into true business advisors.” Henley sees this evolution as essential in a changing market. “When you focus on the success of others, everyone wins,” he said. To learn more, visit nuso.cloud or stop by their booth if you're attending Channel Partners this week. Listen to the full podcast at TelecomReseller.com or on your favorite platform.

In this insightful episode, Dr. Burleson is joined by Blake Morgan, customer experience futurist and bestselling author of More is More: How the Best Companies Go Farther and Work Harder to Create Knock-Your-Socks-Off Customer Experiences. Blake shares powerful lessons from her book and real-world examples from top companies like One Medical and Amazon.Blake emphasizes that great customer experiences start with a strong internal culture and happy, well-equipped employees. The conversation explores how companies can differentiate in a sea of sameness by being relentlessly customer-centric—from streamlined operations to hiring for attitude and integrity.Healthcare professionals, especially those in elective care, will find actionable advice on improving patient experience, embracing digital transformation, and building engaged teams that thrive.What You'll Learn:Why customer experience starts with employee experience—and how culture drives profitabilityHow One Medical disrupts traditional healthcare through intentional design and empathyWhat Amazon gets right by being obsessively focused on the customerWhy logistics, technology, and internal efficiencies are the “invisible levers” of great serviceHow small business owners can lead by example and build service-oriented teamsHiring tips for identifying the “servant leaders” who elevate customer careHow to adapt to change and embrace disruption (with help from a surprising fish metaphor!) Resources & Mentions:More is More by Blake MorganThe Customer of the Future (Blake's upcoming book)The Employee Experience Advantage by Jacob MorganOne Medical, Amazon, and Ritz-Carlton customer experience examplesGallup research on employee engagementThe “CX Imperative” and the Mexican tetra fish—yes, really!Connect with Blake:

The goal of CPR is to keep the brain and vital organs perfused until return of spontaneous circulation (ROSC) is achieved.Post-arrest care and recovery are the final two links in the chain of survival.Identification of ROSC during CPR.Initial patient management goals after identifying ROSC.The patient's GCS/LOC should be evaluated to determine if targeted temperature management (TTM) is indicated.Patients that cannot obey simple commands should receive TTM for at least 24 hours.Recently published studies on TTM and ACLS's current standard.Monitoring the patient's core temperature during TTM.Patients can undergo EEG, CT, MRI, & PCI while receiving TTM.Good luck with your ACLS class!Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/Safe Meds VIP - Learn about medication safety and download a free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vipPass ACLS Web Site - Episode archives & other ACLS-related podcasts: https://passacls.com@Pass-ACLS-Podcast on LinkedIn No statistical diff (TTM2 summary): https://www.ahajournals.org/doi/10.1161/JAHA.122.026539

Send us a textWho knew that the breakthrough moment of AI sentience would come from interacting with an annoying neo-Luddite?After failing to raise a single dollar for PCI's newest initiative — the $350 billion Transdisciplinary Institute for Phalse Prophet Studies and Education (TIPPSE) —  Jason, Rob, and Asher devise the only profitable pitch for raising capital: using AI technology to cure the loneliness that technology itself causes. The only problem is that AI chatbots won't talk to us, as evidenced by Asher's experience of being blocked by an AI “friend.” So Asher turns to the flesh-and-blood author of Blood in the Machine, Brian Merchant, to discuss the rise of the neo-Luddite movement — the only people who might be able to stand your humble Crazy Town hosts. Brian Merchant is a writer, reporter, and author. He is currently reporter in residence at the AI Now Institute and publishes his own newsletter, Blood in the Machine, which has the same title as his 2023 book. Previously, Brian was the technology columnist at the Los Angeles Times and a senior editor at Motherboard.Originally recorded on 1/3/25 (warm-up conversation) and 3/24/25 (interview with Brian).Warning: This podcast occasionally uses spicy language.Sources/Links/Notes:Press Release announcing closure of TIPPSEFunding for FriendScreenshot of Asher's conversation with Friend's bot, FaithLyrics to “Not Going to Mars” by PyrrhonBrian Merchant's Substack, Blood in the MachineBrian's book, Blood in the Machine: The Origins of the Rebellion Against Big Tech  New York Times article on the Luddite Club: “‘Luddite' Teens Don't Want Your Likes”Crazy Town Episode 72: Sucking CO2 and Electrifying Everything: The Climate Movement's Desperate Dependence on Tenuous TechnologiesBrian's essay in The Atlantic, “The New Luddites Aren't Backing Down”Support the show

The chain of survival for ACLS is the same as was learned in your BLS class.The beginning steps of the Cardiac Emergency and Stroke chain of survival.ACLS's timed goals for first medical contact to PCI for STEMI and door-to-needle for ischemic stroke. Characteristics of areas that have significantly better stroke and out-of-hospital cardiac arrest outcomes.Good luck with your ACLS class!Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/Safe Meds VIP - Learn about medication safety and download a free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vipPass ACLS Web Site - Episode archives & other ACLS-related podcasts: https://passacls.com@Pass-ACLS-Podcast on LinkedIn

Watch on YouTubeTedd Huff & John Gordon, CEO of ValidiFI, explore key shifts in Fintech and focus on Account Validation Technology. The focus is on account validation, fraud detection, and customer risk. With over 25 years in financial services, Gordon shares insights from his work at TransUnion and ValidiFI. He explains how behavioral signals like multiple emails, landlines, or shared accounts—can trigger higher risk. Gordon also breaks down why ACH transactions remain dominant, and how high-risk accounts show 11.5x more return failures. The episode covers challenges with virtual bank accounts, especially from neo banks, and how lenders can better identify stable users.John highlights how linking emails, phone types, and account behavior to reduce fraud and improve onboarding. He shares how AI and alternative data fill gaps left by outdated credit models, especially for BNPL users or consumers without full credit files.He predicts a rise in consumer control over financial data and warns that limited access may hurt repayment assessments. For fintech founders, his advice is clear: look at the full data picture account history, contact info, and usage to make better, faster decisions.Key Highlights

N Engl J Med 2005;353:1095-1104Background: Prior trials on revascularization in patients with acute coronary syndromes without ST-segment elevation have yielded mixed results. While FRISC II and TACTICS-TIMI 18 demonstrated a significant reduction in myocardial infarction, this benefit was not observed in RITA 3. None of these trials showed a significant reduction in mortality. Further research is needed to guide treatment strategies in this population, particularly after the introduction of early use of clopidogrel and intensive lipid-lowering therapy.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.The Invasive versus Conservative Treatment in Unstable Coronary Syndromes (ICTUS) trial sough to test the hypothesis that an early invasive strategy is superior to selective invasive strategy for patients with non-ST elevation myocardial infarction (NSTEMI).Patients: Eligible patients had to have all of the following: Worsening symptoms of ischemia or symptoms at rest with the last episode being 24 hours before randomization, elevated cardiac troponin T level (≥0.03 μg per liter); and either ischemic EKG changes (defined as ST-segment depression or transient ST-segment elevation exceeding 0.05 mV, or T-wave inversion of ≥0.2 mV in two contiguous leads) or a documented history of coronary artery disease.Patients were excluded if they were older than 80 years, had an indication for primary percutaneous coronary intervention or fibrinolytic therapy, hemodynamic instability or overt congestive heart failure, oral anticoagulant drugs use in the past 7 days, fibrinolytic treatment within the past 96 hours, percutaneous coronary intervention within the past 14 days, elevated bleeding risk, plus others.Baseline characteristics: The trial randomized 1,200 patients from 42 Dutch hospitals – 604 randomized to early invasive strategy and 596 randomized to selective invasive strategy.The average age of patients was 62 years and 74% were men. Approximately 39% had hypertension, 14% had diabetes, 35% had hyperlipidemia, 23% had prior myocardial infarction and 41% were current smokers.Approximately 48% of the patients had ST deviation equal to or greater than 0.1 mV.Procedures: Patients were randomly assigned in a 1:1 ratio to undergo early invasive vs selective invasive strategy.Patients received 300 mg of aspirin at the time of randomization, followed by at least 75 mg daily indefinitely, and enoxaparin (1 mg/kg for a maximum of 80 mg) subcutaneously twice daily for at least 48 hours. The early use of clopidogrel (300 mg immediately, followed by 75 mg daily) in addition to aspirin was recommended to the investigators after the drug was approved for acute coronary syndrome in 2002. Intensive lipid-lowering therapy, preferably atorvastatin 80 mg daily or the equivalent was recommended as soon as possible after randomization. All interventional procedures during the index admission were performed with the use of abciximab.Patients assigned to the early invasive strategy were scheduled to undergo angiography within 24 - 48 hours after randomization. Patients assigned to the selective invasive strategy underwent coronary angiography if they had refractory angina despite optimal medical therapy, hemodynamic or rhythm instability, or significant ischemia on pre-discharge exercise test.In both groups, percutaneous coronary intervention (PCI) was performed when appropriate, without providing more details in the manuscript.The level of creatine kinase MB was measured at 6-hour intervals during the first day, after each new clinical episode of ischemia, and after each percutaneous revascularization procedure.Endpoints: The primary endpoint was a composite of all-cause death, myocardial infarction, or rehospitalization for angina at 1-year.The estimated sample size to provide 80% power to detect 25% relative risk difference between the two treatment groups at 5% alpha was 1,200 patients. This assumed that 21% of the patients in the early invasive arm would experience the primary outcome.Results: During the index admission, 98% of the patients in the early invasive strategy arm underwent coronary angiogram compared to 53% in the selective invasive arm. At 1-year, 79% of the patients in the early invasive strategy arm underwent revascularization compared to 54% in the selective invasive arm.The primary outcome was not significantly different between both treatment groups (22.7% with early invasive vs 21.2% with selective invasive, RR: 1.07; 95% CI: 0.87 - 1.33; p= 0.33). All-cause death was the same in both groups (2.5%). Myocardial infarction was significantly higher with the early invasive strategy (15.0% vs. 10.0%, RR: 1.50, 95% CI: 1.10 – 2.04; p= 0.005), while rehospitalization for angina was lower with early invasive (7.4% vs. 10.9%, RR: 0.68, 95% CI: 0.47 – 0.98; p= 0.04). Most myocardial infarctions were revascularization related and these were significantly more frequent with early invasive (11.3% vs 5.4%). Spontaneous myocardial infarctions were 3.7% with early invasive and 4.6% with selective invasive and this was not statistically significant.Major bleeding, not related CABG, during the index admission was more frequent with the early invasive strategy (3.1% vs 1.7%).There were no significant subgroup interactions for the primary outcome, including based on ST deviation and troponin levels.Conclusion: In patients with NSTEMI, an early invasive strategy was not superior to selective invasive strategy in reducing the composite endpoint of all-cause death, myocardial infarction, or rehospitalization for angina at 1-year. An early invasive strategy was associated with more myocardial infarctions with a number needed to harm of 20 patients, which was secondary to revascularization related myocardial infarction. An early invasive strategy reduced rehospitalization for angina with a number needed to treat of approximately 29 patients.The ICTUS trial showed that revascularization can cause harm and highlighted how counting procedural myocardial infarctions can influence outcome estimates. While there is ongoing debate about the significance of periprocedural myocardial infarctions, evidence indicates an association with increased mortality. Whether periprocedural myocardial infarctions are 'less severe' than spontaneous myocardial infarctions remains controversial, as their impact varies based on infarct size and patient characteristics. This underscores the importance of including all-cause mortality or advanced systolic heart failure as endpoints in trials of revascularization.Patients in ICTUS received better background medical therapy compared to prior trials in this area. While this could be responsible for the divergent results compared to other prior trials. It also highlights the heterogeneity of NSTEMI patients and that an invasive strategy is not appropriate for all.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

Stopping oral anticoagulation after AF ablation, the core problem with paradoxes like the smoker's paradox, chronic total occlusion PCI, and an ACC/EHRA preview are discussed by John Mandrola, MD, in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I Oral Anticoagulation after Successful AF Ablation Iwawakie et al https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2831851 OCEAN protocol paper https://doi.org/10.1016/j.ahj.2017.12.007 II Smoker's Paradox Presch et al https://www.jacc.org/doi/10.1016/j.jcin.2024.12.028 Gupta et al https://doi.org/10.1161/JAHA.116.003370 III CTO PCI Main sub-analysis paper Bangalore et al https://doi.org/10.1016/j.jacc.2025.01.029 DECISION CTO https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.031313 Main EURO CTO trial https://doi.org/10.1093/eurheartj/ehy220 3-year MACE of EURO CTO https://eurointervention.pcronline.com/article/three-year-outcomes-of-eurocto-a-randomized-multicentre-trial-comparing-revascularization-and-optimal-medical-therapy-for-chronic-total-coronary-occlusions EXPLORE https://www.jacc.org/doi/abs/10.1016/j.jacc.2016.07.744 ISCHEMIA CTO https://www.clinicaltrials.gov/study/NCT03563417   IV ACC and EHRA Preview Mandrola's 5 Trials to Look for at the 2025 American College of Cardiology Scientific Sessions https://www.medscape.com/viewarticle/mandrolas-5-trials-look-2025-american-college-cardiology-2025a10006zu You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

The Lancet 2002;360:743-751Background: The TACTICS-TIMI 18 trial showed that an early invasive strategy in beneficial in selected patients with unstable angina or non-ST-elevation myocardial infarction (NSTEMI). These positive findings contrasted the findings from some earlier studies.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.The British Heart Foundation RITA 3 randomized trial sought to compare invasive vs conservative strategy in patients with unstable angina or NSTEMI, similar to the trial question of TACTICS-TIMI 18.Patients: Eligible patients had suspected cardiac chest pain at rest with at least one of the following: Evidence of ischemia on electrocardiogram (ST depression, transient ST elevation, old left bundle branch block, or T wave inversion), pathologic Q waves suggesting previous myocardial infarction, or documented coronary artery disease on prior coronary angiogram.Patients were excluded if they had evolving myocardial infarction in which reperfusion therapy was indicated. Patients were also excluded if creatine kinase or creatine kinase MB concentrations were twice the upper limit of normal before randomization, if they had myocardial infarction within a month, had percutaneous coronary intervention (PCI) in the previous 12 months, or coronary artery bypass grafting (CABG) at any time.Baseline characteristics: The trial randomized 1,810 patients – 895 randomized to the invasive strategy and 915 randomized to conservative strategy. Patients were recruited from 45 hospitals in England and Scotland.The average age of patients was 63 years and 62% were men. Approximately 35% had hypertension on drugs, 13% had diabetes and 28% had prior myocardial infarction.The majority (92%) of the patients were enrolled because they met the criteria for evidence of ischemia on electrocardiogram.Procedures: Patients were randomly assigned in a 1:1 ratio to undergo invasive vs conservative strategy.In the conservative arm, patients received aspirin and enoxaparin 1mg/kg subcutaneously twice a day for 2-8 days. Beta-blockers, other antiplatelets and glycoprotein IIb/IIIa inhibitors could also be used. Coronary angiography could be performed if patients had anginal symptoms at rest or with minimal exertion despite appropriate therapy or if they had ischemia on stress testing.Patients in the invasive strategy arm received similar medical therapy to the conservative arm. Coronary angiogram was to be performed as soon as possible after randomization and ideally within 72 hours. Revascularization was recommended for lesions of at least 70% stenosis or 50% or more if left main.Endpoints: The trial had two co-primary outcomes. The first was a composite of death from any cause, nonfatal myocardial infarction, or refractory angina at 4 months. The second was a composite of death from any cause or nonfatal myocardial infarction at 1 year.Analysis was performed based on the intention-to-treat principle. The estimated sample size to provide 80% power at 5% alpha, was 1,770 patients. This assumed that 12% of the patients in the conservative arm would experience the outcome of death or non-fatal myocardial infarction at 1-year, and that the invasive strategy would result in 33% relative risk reduction in this outcome.Results: In the invasive strategy, 97% of the patients underwent coronary angiogram at a median of 2 days after randomization, and 55.3% underwent PCI or CABG. In the conservative arm, 10.3% had revascularization during the index admission, and 17.3% had revascularization at 1-year. The median follow time was 2 years and 97% of the patients had at least 1-year of follow up.The first primary composite outcome of death from any cause, nonfatal myocardial infarction, or refractory angina at 4 months was lower with the invasive strategy (9.6% vs 14.5%, HR: 0.66, 95% CI: 0.51 – 0.85; p= 0.001). The second primary composite outcome of death from any cause or nonfatal myocardial infarction at 1 year was not significantly different between both groups (7.6% with invasive vs 8.3% with conservative, HR: 0.91, 95% CI: 0.67 – 1.25; p= 0.58). At 1-year, 4.6% patients died in the invasive arm compared to 3.9% in the conservative arm, and this was not statistically significant. Myocardial infarction at 1-year occurred in 3.8% of the patients in the invasive arm compared to 4.8% in the conservative arm, and this was not statistically significant as well.All bleeding occurred in 8.2% in the invasive arm and 3.5% in the conservative arm.Subgroup analysis showed that men benefited from an invasive strategy while women did not (p for interaction= 0.011). The endpoint of death or myocardial infarction at 1-year, in women, was 5.1% in the conservative arm and 8.6% in the invasive arm, while in men, the incidence of this endpoint was 10.1% in the conservative arm and 7.0% in the invasive arm.Conclusion: In patients with unstable angina or NSTEMI, an invasive strategy compared to conservative strategy, reduced refractory angina but not myocardial infarction or death at 1-year.The reduction in angina is a subjective endpoint, prone to bias and faith healing, as we have previously discussed in other trials of PCI. The reduction in this endpoint alone should not justify widespread adoption of invasive strategy for unstable angina or NSTEMI.A key distinction between this trial and TACTICS-TIMI 18—which demonstrated a reduction in myocardial infarction with an invasive approach—is that this study included patients with smaller myocardial infarctions. Only 41% of participants had ST depression or transient ST elevation, and patients were excluded if creatine kinase or creatine kinase MB levels were more than twice the upper limit of normal before randomization. This highlights the heterogeneity among patients with unstable angina and NSTEMI, where baseline risk and the extent of myocardial necrosis influence treatment effects. We encourage you to read again the subgroup interactions of TACTICS-TIMI 18.Additionally, in the current era, high-sensitivity troponin assays enable the detection of smaller myocardial infarctions, potentially limiting the applicability of older trial results to all present NSTEMI patients.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

In a special Technology Reseller News podcast, Clinton Fitch, Director of Strategic Partnership at Ooma, joined Doug Green to discuss the fast-shifting landscape of POTS line replacement—and why now is the time for both enterprises and exchange carriers to act. With over 171 million POTS lines in the U.S. in 2005, that number has plummeted to just 11.6 million in 2024, according to Telegeography. While most standard voice lines have been replaced, critical-use analog lines—such as elevator phones, fire panels, and fax machines—remain. These are now under increasing threat, as carriers begin rapidly sunsetting copper networks. “The time for POTS replacement is now,” said Fitch, citing recent announcements such as AT&T's plan to exit copper entirely by 2029. With the FCC's 2019 ruling now fully in effect, carriers are allowed to abandon copper and charge premium prices for maintaining legacy lines. The result: exchange carriers and their customers may receive only 30–90 days' notice before a vital analog line is shut down. Enter Ooma AirDial®—a certified, all-in-one cloud-based solution designed to replace legacy POTS lines with support for elevators, fire alarms, entry systems, modems, fax machines, and more. AirDial is certified by NFPA, the New York Fire Department, and the California State Fire Marshal, and supports HIPAA and PCI compliance. Built for rapid deployment, Ooma AirDial® offers: Dual-path connectivity (Ethernet + LTE) with MultiPath Transport™ for maximum reliability Remote Device Management via a secure, intuitive cloud platform Patented packet duplication for seamless call continuity Carrier-ready flexibility for white-label and managed service deployment According to Ooma's recent survey conducted with CIO Magazine, over 50% of organizations are actively evaluating or replacing their POTS infrastructure. But for the remaining users—many of whom are unaware of copper sunset deadlines—the window for a smooth transition is rapidly closing. “We're entering a traffic jam,” warned Fitch. “By 2027–2029, demand will outstrip supply for solutions, deployments, and expertise. If you're not starting now, you risk getting stuck at the back of the line—and your elevators, alarms, and other systems may stop working.” Ooma AirDial® is available now to exchange carriers, MSPs, and end customers—either through direct purchase or via carrier partnerships. With tens of thousands of units already deployed across healthcare, retail, education, and property management sectors, the solution is proven and ready to scale. Learn more at www.ooma.com/business/airdial, or reach out directly at exchangecarrier@ooma.com to start your strategy discussion today.

DESCRIPTION Rafael Abanilla, PTMP, CPP, Senior Vice President at Parking Concepts, discusses Breeze, Parking Concepts and client success. SPONSORS For a quarter century, the Parking Industry Expo has been where parking professionals come to shape the future of our industry. This March 31st through April 3rd, join us as we celebrate PIE's 25th anniversary – our biggest and most innovative expo yet. Connect with industry leaders, discover cutting-edge technologies, and be part of the next chapter in parking excellence. Don't miss this milestone event. Register now at parkingtoday.com/pie25 and use discount code ParkingPod25 for an exclusive 50% off Parking Podcast discount. This episode is brought to you by Parker Technology, the customer experience solution of choice for the parking industry. Our solution puts a virtual ambassador in every lane, to help parking guests pay and get on their way in under a minute. Whether you utilize our customer service team, your team in conjunction with our software platform, or a combination of both, we help you capture revenue, provide better customer service, enable your staff to focus on higher priority tasks, and keep traffic moving. With the Parker Technology solution, you'll also enjoy access to real-time call data and recordings. Learn more at parkertechnology.com/parkingpodcast and subscribe to our podcast “Harder Than It Looks: Parking Uncovered.” This episode is brought to you by Scheidt & Bachman USA. Scheidt & Bachmann USA markets state-of-the-art Parking Solutions and Fare Collection Systems: the most innovative and advanced solutions in the US. Learn more at scheidt-bachmann-usa.com. This episode is brought to you by Breeze: Parking Concepts' digital platform that makes the parking experience a Breeze! For more than 50 years, PCI has been proactively managing parking & transportation operations with unparalleled integrity & service. Learn more at parkingconcepts.com. This episode is brought to you by Parkmobile. Parkmobile, a part of EasyPark Group, is the leading provider of smart parking and mobility solutions in North America, using a contactless approach to help millions of people easily find, reserve, and pay for parking on their mobile devices. Learn more about parkmobile.io. This episode is brought to you by Parkalytics. I wish this solution was around when I was an operator and consultant doing parking studies and chasing parking lease deals. What Parkalytics does is that they will take drone images of parking lots and/or on-street parking for a given time period and then upload those images into their parkalytics software. Within a matter of seconds, it will provide you parking counts, turnover studies, utilization studies, you name it. You can now wow your clients or supervisors by having a complete snapshot of the parking usage for a fraction of the price of a traditional parking study. Learn more at parkalytics.com. WEBSITES AND RESOURCES https://www.parkingcast.com/ https://parkingtoday.com/podcast/ www.parkertechnology.com/parkingpodcast scheidt-bachmann-usa.com parkingconcepts.com https://parkingconcepts.com/breeze/ https://parkmobile.io/ https://www.parkalytics.com/ 2025 PARKING TODAY PIE CONFERENCE HUGE DISCOUNT: Visit parkingtoday.com/pie25 and use discount code ParkingPod25 for an exclusive 50% off discount as a fan of The Parking Podcast. MERCH Check out some of our awesome parking themed t-shirts and other merch at parkingcast.com/swag. MUSEUM Check out some of our artifacts from the world's first parking museum at parkingcast.com/museum.

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In this episode, we review the new 2025 ACC/AHA Acute Coronary Syndrome (ACS) guidelines, with a particular focus on guideline recommendations for analgesics, P2Y12 inhibitors, parenteral anticoagulation, and lipid management. Key Concepts Nitrates and opioids are recommended for symptomatic relief of chest pain. Some patients may not be appropriate for nitrates (e.g. recent PDE-5 inhibitor use, hypotension, or right ventricular infarction). Opioids are used for nitrate-refractory angina but have a theoretical risk of delaying the effect of oral antiplatelet medications. Prasugrel and ticagrelor are preferred P2Y12 inhibitors over clopidogrel in most patients. Patient-specific factors, including the use of PCI, play a role in P2Y12 inhibitor selection. Anticoagulation with heparin is recommended in nearly all acute coronary syndrome (ACS) scenarios. Alternative anticoagulants may be used depending on whether PCI/CABG is planned and whether the anticoagulant is used prior to PCI/CABG (“upstream”) or during the PCI procedure itself. LDL goals after ACS have changed again. All ACS patients should have an LDL goal < 70 with a consideration of an LDL goal of 55-69. A variety of non-statin therapies may be added to a high intensity statin regimen if LDL is not at goal. References Rao SV, O'Donoghue ML, Ruel M, et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. Published online February 27, 2025. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001309

CardioNerds (Dr. Rick Ferraro and Dr. Dan Ambinder) join Dr. Sri Mandava, Dr. David Meister, and Dr. Marissa Donatelle from the Columbia University Division of Cardiology at Mount Sinai Medical Center in Miami. Expert commentary is provided by Dr. Pranav Venkataraman.   They discuss the following case involving a patient with cardiac sarcoidosis presenting as STEMI:  A 57-year-old man with a history of hyperlipidemia presented with sudden onset chest pain. On admission, he was vitally stable with a normal cardiorespiratory exam but appeared in acute distress and was diffusely diaphoretic. His ECG revealed sinus rhythm, a right bundle branch block (RBBB), and ST elevation in the inferior-posterior leads. He was promptly taken for emergent cardiac catheterization, which identified a complete thrombotic occlusion of the mid-left circumflex artery (LCX) and large obtuse marginal (OM) branch, with no underlying coronary atherosclerotic disease. Aspiration thrombectomy and percutaneous coronary intervention (PCI) were performed, with one drug-eluting stent placed. An echocardiogram showed a left ventricular ejection fraction (EF) of 31%, hypokinesis of the inferior, lateral, and apical regions, and an apical left ventricular thrombus. The patient was started on triple therapy. A hypercoagulable workup was negative. A cardiac MRI was obtained to further evaluate non-ischemic cardiomyopathy. In conjunction with a subsequent CT chest, the results raised suspicion for cardiac sarcoidosis with systemic involvement. In view of a reduced EF and significant late-gadolinium enhancement, electrophysiology was consulted to evaluate for ICD candidacy. A decision was made to delay ICD implantation until a definitive diagnosis of cardiac sarcoidosis could be established by tissue biopsy. The patient was started on HF-GDMT and discharged with a LifeVest. Close outpatient follow-up with cardiology and electrophysiology was arranged.  US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - Cardiac Sarcoidosis Presenting as STEMI Cardiac sarcoidosis can present with a variety of symptoms, including arrhythmias, heart block, heart failure, or sudden cardiac death. Symptoms can be subtle or mimic other cardiac conditions.  Conduction abnormalities, particularly AV block or ventricular arrhythmias, are common and may be the initial indication of cardiac involvement with sarcoidosis.  The additive value of Echocardiography, FDG-PET, and cardiac MR is indispensable in the diagnostic workup of suspected cardiac sarcoidosis.  Specific role of MRI/PET: Both cardiac MRI and FDG-PET provide a complementary role in the diagnosis of cardiac sarcoidosis. Cardiac MRI is an effective diagnostic screening tool with fairly high sensitivity but is limited by its inability to decipher inflammatory (“active” disease) versus fibrotic myocardium. FDG-PT helps to make this discrimination, refine the diagnosis, and guide clinical management. Ultimately, these studies are most useful when interpreted in the context of other clinical information.  Primary prevention of sudden cardiac death in cardiac sarcoidosis focuses on risk stratification, with ICD placement for high-risk patients. For patients awaiting definitive diagnosis, a LifeVest may be used as a temporary measure to protect from sudden arrhythmic events until an ICD is placed.  Notes - Cardiac Sarcoidosis Presenting as STEMI 1. Is STEMI always a result of coronary artery disease?  By definition, a STEMI is an acute S-T segment elevation myocardial infarction. This occurs when there is occlusion of a major coronary artery, which results in transmural ischemia and damage,

N Engl J Med 2001;344:1879-1887Background: Acute coronary syndrome is broadly categorized into unstable angina, non-ST-elevation myocardial infarction (NSTEMI) and ST-elevation myocardial infarction (STEMI). In unstable angina, there is no rise in cardiac biomarkers, although some challenge this clinical entity in the current era of high sensitivity troponins. In NSTEMI, there is elevation of cardiac biomarkers but no ST segment elevation on the electrocardiogram. In STEMI, there is an ST segment elevation on the electrocardiogram as well as a rise in cardiac biomarkers.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.In patients with STEMI, percutaneous coronary intervention (PCI) significantly improves outcomes. However, its role in acute coronary syndrome without ST-segment elevation is less clear for several reasons. Patients with NSTEMI tend to be older and have more comorbidities, increasing procedural risks. This also means that they have competing risks for mortality, potentially reducing the benefit of PCI. Another key challenge is that NSTEMI patients frequently have multivessel disease, making it more difficult to identify the culprit lesion; since there is usually only partial occlusion of the culprit coronary artery. In contrast, there is usually complete occlusion of a coronary artery in STEMI and ST-segment elevation on the electrocardiogram helps localize the infarcted area, making it relatively easy to identify the culprit artery.The findings from previous randomized trials of revascularization in unstable angina and NSTEMI, have been inconsistent. The TACTICS–Thrombolysis in Myocardial Infarction 18 trial sought to compare early invasive vs conservative strategy in patients with unstable angina or NSTEMI.Patients: Eligible patients had angina within 24 hours that was: >20 minutes in duration, accelerating angina, or recurrent episodes at rest or with minimal effort. Patients also had to have one of the following: ST-segment depression of at least 0.05 mV, transient ( 2.5 mg/dL.Baseline characteristics: The trial randomized 2,220 patients – 1,114 randomized to early invasive strategy and 1,106 randomized to conservative strategy.The average age of patients was 62 years and 66% were men. Approximately 28% had diabetes and 39% had prior myocardial infarction.Troponin T levels were elevated (>0.01 ng/ml) in 54% of the patients.Procedures: Patients were randomly assigned in a 1:1 ratio to undergo early invasive vs conservative strategy.Patients received aspirin 325 mg daily, intravenous unfractionated heparin (5000U bolus, followed by an infusion at 1000U/ hour for 48 hours), and intravenous tirofiban (0.4 μg/kg/minute for 30 minutes followed by an infusion of 0.1 μg/kg/minute for 48 hours or until revascularization with tirofiban administered for at least 12 hours after PCI).Patients in the early invasive arm underwent coronary angiogram between 4 and 48 hours after randomization and underwent PCI as appropriate. Patients in the conservative arm were treated medically. If stable, they underwent an exercise-tolerance test before discharged (83% of these tests were with nuclear perfusion or echocardiography imaging). Patients in the conservative arm underwent coronary angiography with PCI if they had angina at rest associated with ischemic EKG changes or elevation in cardiac biomarkers, had clinical instability or had ischemia on their stress test.Endpoints: The primary outcome was a composite of death from any cause, nonfatal myocardial infarction, and rehospitalization for an acute coronary syndrome, at six months.The estimated sample size to provide 80% power was 1,720 patients. This assumed that 22% of the patients in the conservative arm would experience the primary outcome and that the early invasive strategy would result in 25% relative risk reduction in the primary outcome. The sample size was later increased to 2,220 patients.Results: In the early invasive strategy, 97% of the patients underwent coronary angiogram after a medium of 22 hours after randomization, and 60% underwent PCI or CABG. In the conservative arm, 51% underwent coronary angiogram and 36% underwent revascularization during the index hospitalization.The primary composite endpoint was lower with the early invasive strategy (15.9% vs 19.4%, odds ratio: 0.78, 95% CI: 0.62 - 0.97; p= 0.025). The Kaplan-Meier curves started to separate at approximately one week. This benefit was driven by lower myocardial infarction and lower rehospitalization for an acute coronary syndrome with the early invasive strategy; (4.8% vs 6.9%) and (11.0% vs 13.7%), respectively. There was no difference in all-cause death (3.3% vs 3.5%).There were 3 important subgroup interactions. First is based on ST changes where patients with ST changes at presentation had all the benefit with an early invasive strategy (16.4% vs 26.3% [for patients with ST changes] and 15.6% vs 15.3% [for patients without ST changes]). Second is based on Troponin T levels where patients with troponin T> 0.1 ng/mL had significantly more benefit with an early invasive strategy (16.4% vs 24.5% and 15.1% vs 16.6%). The third is based on TIMI score where patients with higher TIMI score had more benefit with an early invasive approach. For a high TIMI score of 5-7, the event rate was 19.5% with early invasive vs 30.6% with conservative approach. Patients with TIMI score of 0-2 had no benefit with an early invasive strategy (12.8% with early invasive vs 11.8% with conservative strategy).Note to readers: TIMI score is a risk stratification tool used to predict 14-day adverse outcomes in patients with unstable angina or NSTEMI. The score ranges from 0 to 7 with higher scores indicating worse prognosis.Conclusion: In patients with unstable angina or NSTEMI, an early invasive strategy reduced the composite endpoint of death from any cause, nonfatal myocardial infarction, and rehospitalization for an acute coronary syndrome at six months with a number needed to treat of approximately 29 patients.The subgroup analysis of this trial is particularly important and biologically plausible, as the presence of ST changes and level of cardiac biomarkers elevation indicate more significant myocardial ischemia or necrosis. Patients without ST changes comprised 62% of the study participants, while those with negative cardiac biomarkers made up 59%, and the study results should not be generalized to these subgroups.Another key consideration is the lack of detailed criteria for what was deemed ‘appropriate' revascularization. Only 60% of patients in the early invasive strategy group underwent revascularization, underscoring that not all patients with unstable angina or NSTEMI benefit from coronary angiography and that further risk stratification is necessary.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

The chain of survival for a cardiac emergency and stroke start the same: 1. preparedness & recognition of an emergency; 2. activation of EMS; 3. delivery of Advanced Life Support; and 4. transporting to the most appropriate facility.ALS ambulances are staffed with paramedics who have training in ACLS skills. Why EMS "Destination Protocols" for suspected stroke and STEMI make a difference.ACLS's timed benchmarks for:point of first medical contact to PCI for ST elevation MI;door to tPA for ischemic stroke; andonset of symptoms to EVT for LVO strokes.Why EMS should bypass a close hospital to transport a STEMI or suspected stroke patient to a hospital capable of 24/7 PCI or a certified stroke center. Check out the Pod Resource page at passacls.com for links to the "EMS On Air" podcast for links to episodes that look at EMS's role in stroke outcomes in the rural vs urban area.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting. Donations at Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated and will help ensure others can benefit from these tips as well.Good luck with your ACLS class!Helpful Listener Links:Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/

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Cloud Connections 2025 Preview: BroadSource's SecurePII Takes Center Stage March 2025 – Technology Reseller News – BroadSource has officially launched SecurePII, a cutting-edge real-time redaction platform designed to protect Personally Identifiable Information (PII) in telecommunications networks. In a special Cloud Communications Alliance (CCA) podcast, Haydn Faltyn and Bill Placke from BroadSource joined Doug Green to discuss the technology, its market impact, and why service providers should take notice. The Growing Need for Real-Time PII Protection BroadSource has long been a leader in delivering technology solutions to cloud communications providers. With SecurePII, they are addressing a critical issue in telecommunications: how to protect PII that traverses carrier networks. The demand for real-time data redaction has surged due to increasing regulatory requirements, including CCPA, GDPR, HIPAA, and the evolving PCI DSS 4.0 standard. Faltyn explains: “We launched SecureCall as a PCI-compliant platform for credit card redaction last year. But service providers and enterprises alike need more—protection beyond just payment information. SecurePII extends our technology to safeguard all forms of personal data in voice communications.” Shifting the Compliance Conversation Placke highlights the legal and compliance challenges that enterprises face, as regulators worldwide introduce stricter measures around data privacy. “Legal teams are often forced to say ‘no' to new initiatives because of concerns over PII exposure. SecurePII flips the script—by redacting sensitive data in real time, businesses can fully leverage AI, analytics, and automation without compliance roadblocks.” A Game Changer for AI-Driven Business Communications The rise of AI and large language models (LLMs) has created a data dilemma for enterprises: how can they safely utilize voice data for AI applications, customer analytics, and automation without violating data privacy laws? With SecurePII, BroadSource provides a solution that allows organizations to extract value from their data without storing or processing sensitive customer information. By removing PII in real-time, businesses can: Enhance AI training models without compliance risks Increase customer trust by ensuring privacy protection Reduce operational risks and costs associated with data breaches and regulatory fines Impact on Contact Centers and CX A core use case for SecurePII is contact centers, where credit card details, account numbers, and personal information are frequently exchanged over voice channels. The platform ensures: Seamless transactions without the risk of human agents being exposed to sensitive data A frictionless customer experience that retains the personal touch while safeguarding information Higher revenue retention—BroadSource has observed a 9% increase in revenue when businesses implement SecurePII in customer interactions BroadSource's SecurePII Roadmap and Upcoming Events The launch of SecurePII marks a new strategic direction for BroadSource, emphasizing data security as a core value for service providers. Faltyn and Placke will be presenting SecurePII at: Cavell's Summit Europe 2025 – A premier event for cloud communications leaders Cloud Connections 2025 (CCA Conference, St. Petersburg, FL) – Where BroadSource will showcase SecurePII's capabilities to global service providers Where to Learn More SecurePII is now live, and service providers can integrate it into their networks today. BroadSource has also launched a dedicated website for SecurePII, providing resources, case studies, and implementation details. Visit: www.securepii.cloud BroadSource's mission is clear—to empower service providers with the tools to protect their networks, comply with global regulations, and enable the future of AI-driven business communications. With SecurePII,

Listener feedback on asymptomatic aortic stenosis (AS), transcatheter aortic valve replacement (TAVR) vs surgical aortic valve replacement (SAVR), coronary artery calcium (CAC), and revascularization for patients with ischemic LV dysfunction are discussed by John Mandrola, MD, in today's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I Aortic Valve Intervention for Asymptomatic AS Asymptomatic Aortic Stenosis: “Time to Act” or Not So Fast? https://www.medscape.com/viewarticle/asymptomatic-aortic-stenosis-time-act-or-not-so-fast-2025a10005o9 EARLY TAVR: A Positive Trial That Fails to Inform Clinical Decisions https://www.medscape.com/viewarticle/early-tavr-positive-trial-fails-inform-clinical-decisions-2024a1000kec Reddy et al: https://doi.org/10.1016/j.jacc.2024.12.031 Wallach editorial https://doi.org/10.1016/j.jacc.2025.01.020 Guerrero https://www.tctmd.com/slide/tavr-young-patients-current-treatment-patterns-us II CAC - Coronary Artery Calcium Coronary Artery Calcium Testing—Too Early, Too Late, Too Often https://jamanetwork.com/journals/jamacardiology/fullarticle/2830950 CAUGHT-CAD https://jamanetwork.com/journals/jama/fullarticle/2831115 III CABG, PCI or Meds for Ischemic LV Dysfunction STICH https://www.nejm.org/doi/full/10.1056/NEJMoa1100356 STICHES https://www.nejm.org/doi/full/10.1056/NEJMoa1602001 REVIVED BCIS https://www.nejm.org/doi/full/10.1056/NEJMoa2206606 EHJ paper https://doi.org/10.1093/eurheartj/ehaf080 IV Preview https://www.medscape.com/viewarticle/shed-lead-and-injuries-should-cath-labs-go-lead-free-2024a1000hnb You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

In this episode of The Burleson Box, Dr. Dustin Burleson welcomes Dr. Erinne Kennedy, Assistant Dean for Curriculum and Integrated Learning at Kansas City University College of Dental Medicine. Dr. Kennedy shares her fascinating journey into dentistry, which was heavily influenced by her family of dental professionals and her passion for public health. She recounts the pivotal moment when a mentor encouraged her to apply for a dental public health specialty—at Harvard—within a two-week deadline, a decision that shaped the course of her career.Our discussion covers the pressing issue of burnout in the dental profession, with Dr. Kennedy offering valuable insights backed by research. She explains how excessive working hours, lack of adequate recovery time, and administrative burdens contribute to burnout among healthcare professionals. Using a compelling analogy comparing work schedules to endurance training, she illustrates the importance of balancing workload and rest. She also introduces the concept of "resilience confetti," small, joyful activities that help dental professionals maintain well-being and engagement during their workday.Dr. Kennedy and Dr. Burleson explore strategies that dental teams can implement to create healthier work environments, such as rethinking office hours, planning meaningful time off, and fostering a culture that prioritizes both patient care and team well-being. They discuss innovative scheduling models, including the effectiveness of three-day, 12-hour shifts, and how such models can improve job satisfaction and reduce burnout.A significant part of the conversation focuses on the future of preventive dentistry. Dr. Kennedy shares her excitement about advancements in salivary testing, peptides, and microbiome management, predicting that these innovations will reshape how dental professionals approach prevention. She explains how new materials and techniques, such as peptide-based remineralization and nanoparticle technology, could reduce the need for surgical interventions and lead to better long-term patient outcomes.As an educator, Dr. Kennedy highlights the importance of emotional intelligence and leadership training in dental schools. She describes the Thrive program at KCU, a two-day workshop designed to help students develop resilience, goal-setting skills, and emotional maturity. She stresses that fostering a mindset of adaptability and openness to unexpected opportunities is crucial for career growth.Wellness Resources:The Genius of Athletes by Noel Brick Ph. D. and Scott DouglasAtomic Habits by James ClearAntibiotic Stewardship Resources:Association for Dental Safety Antibiotic Stewardship ResourcesAmerican Dental Association Antibiotic Stewardship ResourcesCariology Resources:Carequest Managing Dental CariesCarequest Connect Caries Risk Assessments and Cultural AwarenessCarequest Utilizing Caries Management by Risk Assessment to Deliver Person-Centered Care ***The Burleson Box is brought to you by Stax Payments:Save Big on Transaction Fees: Boost Your Bottom Line with Stax Payments.Did you know that your practice can start saving thousands of dollars on your monthly processing costs with our preferred payments partner, Stax? Simplify your practice operations and provide a quality patient experience. Healthcare practices like yours need a way to accept payments simply and securely. That's where Stax comes in.Stax helps you manage your entire payments experience from within one platform. You can safely accept touch-free payments in-person, online, or over the phone, securely store and manage patient information with layered security and Level 1 PCI compliance.
Take advantage of a simpler, more transparent way to process your payments with competitive flat-rate pricing, provided exclusively through Stax. No additional fees or contracts required!Power your practice and get paid faster with simple, safe and secure payment solutions. Have questions? Schedule time to speak with a dedicated payment consultant to learn more.Click Below to Lear More Today:StaxPayments.com/burleson-seminars*** Go Premium: Members get early access, ad-free episodes, hand-edited transcripts, exclusive study guides, special edition books each quarter, powerpoint and keynote presentations and two tickets to Dustin Burleson's Annual Leadership Retreat.http://www.theburlesonbox.com/sign-up Stay Up to Date: Sign up for The Burleson Report, our weekly newsletter that is delivered each Sunday with timeless insight for life and private practice. Sign up here:http://www.theburlesonreport.com Follow Dustin Burleson, DDS, MBA at:http://www.burlesonseminars.com

N Engl J Med 2024;390:1481-1492Background: In patients with ST-elevation myocardial infarction (STEMI), opening the culprit artery improves outcomes. Nearly half of STEMI patients have disease in other coronary arteries. Whether revascularizing these non-culprit arteries improves outcomes remained uncertain. The PRAMI trial showed improvement in outcomes with complete revascularization but was relatively small, included 465 patients, and did not require the use of fractional flow reserve (FFR).Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.The FFR-Guidance for Complete Nonculprit Revascularization (FULL REVASC) trial sought to assess if FFR-guided completed revascularization improves outcomes compared to culprit-only percutaneous coronary intervention (PCI).The COMPLETE trial was not published by the time the FULL REVASC trial started enrolling patients.Patients: Eligible patients had STEMI and were undergoing PCI or had high risk NSETMI undergoing urgent PCI. High risk NSTEMI included patients with dynamic ST–T-wave changes, ongoing chest pain, acute heart failure, hemodynamic instability independent of electrocardiographic changes, or life-threatening ventricular arrhythmias.Eligible patients had to have multivessel coronary artery disease, defined as one or more lesions in a nonculprit artery with a diameter of ≥ 2.5 mm and a visually graded stenosis of 50 - 99%.Patients were excluded if they had previous CABG, left main disease or cardiogenic shock.Baseline characteristics: The trial randomized 1,542 patients – 778 randomized to culprit-only PCI and 764 randomized to complete revascularization. Patients were recruited from 32 centers in 7 countries.Approximately 91% of the patients had STEMI and 9% had high risk NSTEMI.The average age of patients was 65 years and 76% were men. Approximately 51% had hypertension, 16% had diabetes, 23% were on treatment for hyperlipidemia, 8% had prior myocardial infarction, and 35% were current smokers.The number of residual coronary arteries with stenosis of 50-99% was 1 in 72% of the patients and 2 or more in the rest.Procedures: Patients were randomly assigned in a 1:1 ratio to undergo culprit-only PCI or FFR-guide complete revascularization. The study was open label.Patients in the culprit-PCI only group did not receive further revascularization during the index hospitalization. Patients in the FFR-guided complete revascularization could receive further revascularization during the index procedure or during the index hospitalization. PCI of non-culprit lesion was recommended if FFR was 0.80 or less.Endpoints: The primary outcome was a composite of death from any cause, myocardial infarction, or unplanned revascularization. The main secondary outcomes were a composite of death from any cause or myocardial infarction and unplanned revascularizationAnalysis was performed based on the intention-to-treat principle. The estimated sample size to achieve 80% with a two-sided alpha of 0.05 was 4,052 patients. This sample size would detect 0.75 risk ratio for the composite outcome of death or myocardial infarction at 1-year assuming 9.9% event rate in the culprit-only PCI. After the publication of the COMPLETE trial, the trial was stopped early due to ethical and feasibility concerns. Consequently, the original key secondary outcome (death from any cause, myocardial infarction, or unplanned revascularization) became the new primary outcome, and events after 1 year of follow-up were included in the primary analysis.Results: The trial was stopped after randomizing 38.1% of the original sample size. Among the patients assigned to the FFR-guided complete-revascularization arm, the procedure was followed in 95.9% of the patients, and among these patients, 17.9% underwent FFR-guided complete revascularization of non-culprit lesions during the primary PCI and the rest during the index hospitalization. Among the patients assigned to culprit-only arm, the assigned strategy was followed in 99.6% of the patients. The median follow-up time was 4.8 years.FFR was 0.8 or less in 392 (47.3%) of non-culprit vessels assessed, and PCI was performed in 369 (94.1%) of these vessels. In total, PCI was performed in 18.8% of the total non-culprit vessels. The average number of stents during the index hospitalization was 1 in the culprit-only PCI group and 2 in the complete revascularization group.The primary composite outcome was not significantly different between both treatment groups (19.0% with complete-revascularization vs 20.4% with culprit-only PCI, HR: 0.93, 95% CI: 0.74 - 1.17; p= 0.53). There were also no significant differences in composite endpoint of death from any cause or myocardial infarction (16.5% with complete revascularization vs 15.3% with culprit-only PCI) or unplanned revascularization (9.2% with complete revascularization vs 11.7% with culprit-only PCI).Stent thrombosis and stent restenosis were significantly more frequent in the complete revascularization arm (2.5% vs 0.9%, HR: 2.80, 95% CI: 1.18 – 6.67) and (4.2% vs 2.3%, HR: 1.84, 95% CI: 1.03 – 3.28), respectively.Baseline risk or coronary anatomy did not significantly affect subgroup interactions for the primary outcome.Conclusion: In patients with STEMI or high risk NSTEMI, FFR-guided complete revascularization compared to culprit-only PCI, did not improve the outcomes of death from any cause, myocardial infarction, or unplanned revascularization, over a median follow up time of 4.8 years. Complete revascularization resulted in more stent thrombosis and stent restenosis.The study lost some statistical power by stopping early, resulting in a final power of 74%. We disagree with the authors' decision to halt the trial prematurely based on the findings of the COMPLETE trial. COMPLETE was the first large trial to demonstrate a benefit in hard outcomes when revascularizing stable plaques, and its results warrant further confirmation. Furthermore, COMPLETE used different strategy as FFR was not required.Note to readers: Power measures the study's ability to avoid a Type II error (false negative) and it equals 1 - β with β being the probability of a Type II error. In other words, power represents the probability of correctly rejecting the null hypothesis (H₀) when the alternative hypothesis (H₁) is true. Most clinical trials aim for 80% or 90% power. For example, a study with 80% power has a 20% risk of failing to detect a real effect.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

N Engl J Med 2019;381:1411-1421Background Percutaneous coronary intervention (PCI) had been clearly established as the standard of care for ST elevation myocardial infarction. Yet many patients taken for PCI have multiple lesions in addition to the culprit. The benefit of routinely treating additional significant lesions has been unclear, with previous smaller trials showing reductions in composite outcomes primarily driven by reduced revascularization rates.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.The COMPLETE (Complete vs Culprit-Only Revascularization Strategies to Treat Multivessel Disease after Early PCI for STEMI) trial investigated whether performing percutaneous coronary intervention (PCI) on non-culprit lesions reduces cardiovascular risk in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease.Patients The trial enrolled 4,041 patients from 140 centers in 31 countries between February 2013 and March 2017. Eligible patients had STEMI with successful culprit-lesion PCI and at least one non-culprit coronary artery lesion with ≥70% stenosis (or 50-69% stenosis with FFR ≤0.80) in a vessel ≥2.5mm in diameter. Patients were randomized within 72 hours after successful culprit-lesion PCI. Exclusion criteria included planned surgical revascularization and previous coronary bypass surgery.Baseline Characteristics The mean age was approximately 62 years, with about 80% being male. Approximately 19% had diabetes, 8% had previous MI, and 7% had previous PCI. Over 90% of patients underwent primary PCI (vs. pharmacoinvasive or rescue PCI), with 80% using radial access.The groups were well-balanced, with similar SYNTAX scores at baseline and similar culprit and non-culprit lesion characteristics. About 76% had one residual diseased vessel and 24% had two or more. Guideline directed medical therapy was robust and balanced, including more than 99% on dual antiplatelet therapy, 98% on statins, 88% on beta blocker, and 85% on ACEi or ARB.In patients in the complete revascularization group designated for non-culprit PCI during index hospitalization, the mean time to PCI was 1 day. In the group designated for non-culprit PCI after discharge, the mean time was 23 days.Trial procedures Patients were randomized to complete revascularization (n=2,016) or culprit-lesion-only PCI (n=2,025). In the complete revascularization group, investigators specified before randomization whether non-culprit PCI would occur during index hospitalization or after discharge (within 45 days).Everolimus-eluting stents were recommended for all procedures. Both groups received guideline-based medical therapy including dual antiplatelet therapy with aspirin and ticagrelor for at least one year.Endpoints The first coprimary outcome was cardiovascular death or new myocardial infarction. The second coprimary outcome was cardiovascular death, myocardial infarction, or ischemia-driven revascularization. Secondary outcomes included individual components of the composite outcomes, all-cause mortality, and safety outcomes like major bleeding, stroke, and stent thrombosis.Trialists estimated that a sample of 4000 patients would give 80% power to detect a 22% lower risk of the composite of cardiovascular death or myocardial infarction in the complete-revascularization group than in the culprit-lesion-only PCI group, assuming an event rate of 5% per year in the culprit-lesion-only PCI group. The first coprimary outcome was tested at a P value of 0.045 and the second at a P value of 0.0119.The co-primary endpoints were analyzed according to the time to first event approach. Confidence intervals for secondary and exploratory efficacy outcomes were not adjusted for multiple comparisons, and therefore inferences drawn from these intervals may not be reproducible.Results Over a median follow-up of 36.2 months, the first coprimary outcome occurred in 7.8% of the complete-revascularization group versus 10.5% of the culprit-lesion-only group (hazard ratio 0.74, 95% CI: 0.60-0.91; p= 0.004). Benefit was driven by reduced myocardial infarction rates (5.4% vs 7.9%) while cardiovascular death rates were similar (2.9% vs 3.2%).The second coprimary outcome was also reduced with complete revascularization (8.9% versus 16.7%, HR: 0.51, 95% CI: 0.43-0.61; p

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N Engl J Med 2013;369:1115-23Background: The COURAGE trial was published in 2007. It compared up-front PCI to medical therapy alone in patients with stable CAD. Preventive PCI did not reduce the chance of dying or having a heart attack over a median follow up time of 5 years. The results rocked the cardiology world because for years prior to the publication of COURAGE, the standard of care called for revascularization of obstructive coronary stenosis. Despite what we would consider minor criticisms of COURAGE, the results have held over time as a preventive PCI strategy has failed repeatedly to reduce death or MI compared to medicine alone in subsequent large trials (BARI 2D, FAME 2, ISCHEMIA and ISCHEMIA-CKD) involving patients with stable CAD. But what about patients with acute coronary syndromes who have, a clearly defined “culprit” lesion and stable coronary stenosis of a non-infarct vessel? On the surface, the answer might seem simple - treat the “culprit” lesion with PCI and leave the stable disease alone. Continue optimal medical treatment of stable CAD indefinitely with consideration of revascularization only if new symptoms arise. But what if a stable coronary stenosis behaves differently in a patient with an acute coronary syndrome than in patients without it? Are these patients predisposed or particularly susceptible to acute plaque rupture and thrombogenesis to such an extent that they would benefit from a preventive revascularization strategy? The Primary Angioplasty in Myocardial Infarction (PRAMI) trial sought to test the hypothesis that immediate preventive PCI of non-culprit vessels plus the culprit vessel compared to culprit vessel only PCI would improve outcomes in patients with a STEMI and coronary stenosis of a non-infarct related artery.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.Patients: From 2008 through 2013, patients were enrolled from 5 coronary care centers in the United Kingdom. Patients could be any age with acute STEMI and multivessel CAD detected at the time of emergency PCI. The trial was limited to patients with STEMI because ST-segment elevation, unlike ST-segment depression, localizes the area of ischemia in the myocardium and an “infarct-artery” is usually easy to distinguish. Clinically stable patients were considered for eligibility after undergoing PCI of the infarct artery while they were in the catheterization lab. They were eligible if successful PCI of infarct artery was performed and there was stenosis of 50% or more in one or more non-infarct arteries. Exclusion criteria included cardiogenic shock, previous CABG, had left main or significant disease in the ostia of both the LAD and circumflex vessels, or if the only non-infarct stenosis was a chronic total occlusion.Baseline characteristics: The trial screened 2,428 patients and randomized 465 patients (19%) with 234 to preventive PCI and 231 to no preventive-PCI. The majority of patients were excluded for single vessel disease (1122/1922 [58%]). The average age of patients was 62 years and more than 75% were men. Close to 50% were current smokers. The infarct artery was anterior in 35%, inferior in 60% and lateral in 5%. Approximately 65% of patients had 2 vessel disease and 35% had 3 vessel disease.Procedures: After completion of PCI in the infarct artery, eligible patients were randomized and those assigned to the preventive-PCI group underwent the procedure immediately in all non-infarct arteries with a coronary stenosis >50%. PCI was discouraged at a later date (sometimes this strategy is referred to as “staged PCI”) in the no preventive-PCI group unless it was symptom driven. Any patient in the trial with subsequent symptoms of angina that were not controlled with medicine was required to undergo objective assessment of ischemia to secure a diagnosis of refractory angina. Follow-up information was collected at 6 weeks and then yearly thereafter.Endpoints: The primary endpoint was a composite of death from cardiac causes, nonfatal MI, or refractory angina. Secondary outcomes included the individual components of the composite endpoint along with noncardiac death and repeat revascularization. Myocardial infarction was defined as symptoms of cardiac ischemia and a troponin level >99% URL. However, within 14 days after randomization, MI diagnosis also required ECG evidence of new STE or left bundle branch block and angiographic evidence of coronary artery occlusion (essentially this makes it so only in-stent thrombosis or spontaneous STEMI count and other causes of peri-procedural MI do not - this would bias the trial in favor of the preventive-PCI group).Refractory angina was defined as angina despite medical therapy and objective evidence of myocardial ischemia (i.e., ischemia on ECG during spontaneous episode of pain or abnormal results on functional testing).It was determined that 600 patients would be needed to achieve 80% power to detect a 30% relative reduction in the preventive-PCI group, at a 5% level of significance, assuming an annual rate of the primary outcome of 20% in the control group. Stopping criteria were prespecified if the results from the trial showed a primary outcome difference at the 0.001 level of significance. Results: The trial was stopped early based on a significant difference (P50%, preventive PCI significantly reduced a primary composite outcome of cardiac death, nonfatal MI and refractory angina in the PRAMI trial with an estimated NNT of 7 patients over 2 years. Individual components of the primary endpoint that were significantly reduced included nonfatal MI and refractory angina by similarly large margins. These results may seem impressive at first glance but we urge extreme caution in their interpretation. First, this is a relatively small trial with a historically large effect size, especially when considering hard endpoints like cardiac death and nonfatal MI were included. Such results are often later found to be falsely positive when larger, confirmatory studies are conducted. Second, the trial was stopped early and early stopping is prone to yield false positive and/or exaggerated results. Third, inclusion of refractory angina in the primary endpoint, an endpoint susceptible to bias in an unblinded study (see earlier discussion of “faith healing” and “subtraction anxiety” in FAME 2; consideration also must be given to nocebo effects in patients who know they have “untreated blockages”), clouds the main findings by inflating the effect size and making the trial susceptible to large differences in underpowered endpoints before sufficient data can be accumulated on hard outcomes. For example, if the trial had sought to detect a conservative difference of 30% in a primary composite endpoint that only included cardiac death or nonfatal MI, based on an event rate of 12% in the control group (the actual event rate in the trial), over 2,200 patients would be needed for 80% power at a 5% level of significance. The estimated number of actual events would be around 230. However, only 47 events occurred in PRAMI making the results highly susceptible to noise.While results of PRAMI suggest a beneficial role for preventive-PCI in patients with STEMI, more evidence is needed to confirm the results.Thanks for reading Cardiology Trial's Substack! This post is public so feel free to share it. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

Blanking period after AF ablation, periprocedural MI after PCI in non-STEMI, predicting AF after ischemic stroke, and the proper standards for mitral valve repair in primary mitral regurgitation are the topics John Mandrola, MD, discusses in today's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I AF blanking period CIRCA DOSE Research letter https://www.ahajournals.org/doi/10.1161/CIRCEP.124.013232 Circa-Dose https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.119.042622 COMPARE CRYO  https://doi.org/10.1016/j.jacep.2024.03.021 Mohanty et al  10.1016/j.hrthm.2024.08.011 Ruzieh, Foy, Mandrola Patients' Lives Don't Pause for Blanking Periods https://doi.org/10.1016/j.ahjo.2024.100497 II Periprocedural MI and Future events Circulation paper https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.070729 III AI to detect AF related stroke eClinical Medicine Paper  https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(25)00050-1/fulltext IV Mitral Valve Repair JACC paper -- https://doi.org/10.1016/j.jacc.2024.10.108 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net