Podcasts about stemi

Acute Coronary Syndrome refers to a spectrum of conditions including Unstable Angina, Non ST Elevation Myocardial Infarction and ST Elevation Myocardial Infarction. In this video we look at the pathology behind acute coronary syndrome, the differences between Unstable angina, NSTEMI and STEMI, as well as the signs and symptoms, diagnosis (including ECG changes!) and treatment of each. PDFs available here: https://rhesusmedicine.com/pages/cardiologyConsider subscribing (if you found any of the info useful!): https://www.youtube.com/channel/UCRks8wB6vgz0E7buP0L_5RQ?sub_confirmation=1Buy Us A Coffee!: https://www.buymeacoffee.com/rhesusmedicineTimestamps:0:00 What is Acute Coronary Syndrome - Acute Coronary Syndrome Definition0:25 Coronary Artery Anatomy1:17 Acute Coronary Syndrome Pathology - Atherosclerosis 2:08 Acute Coronary Syndrome Pathology - Unstable Angina vs Non ST Elevation Myocardial Infarction vs ST Elevation Myocardial Infarction3:00 Acute Coronary Syndrome Risk Factors3:23 Signs and Symptoms of Acute Coronary Syndrome4:17 Acute Coronary Syndrome Diagnosis - ECG STEMI5:45 Acute Coronary Syndrome Diagnosis - ECG NSTEMI and Unstable Angina6:42 Acute Coronary Syndrome Diagnosis - Cardiac Troponin I 7:11 Acute Coronary Syndrome Diagnosis - Imaging7:42 Treatment of Acute Coronary SyndromeLINK TO SOCIAL MEDIA: https://www.instagram.com/rhesusmedicine/ReferencesBritish National Formulary (BNF), 2015. Acute coronary syndromes – treatment summary. [online] Available at: https://bnf.nice.org.uk/treatment-summary/acute-coronary-syndromes.html. BNFTeachMeAnatomy, 2025. Heart vasculature. [online] Available at: https://teachmeanatomy.info/thorax/organs/heart/heart-vasculature/. TeachMeAnatomy+1DeVon, H.A., 2020. Typical and atypical symptoms of acute coronary syndrome. Journal of the American Heart Association, 9:e015539. [online] Available at: https://www.ahajournals.org/doi/10.1161/JAHA.119.015539. AHA JournalsWarren, A., 2020. Acute coronary syndrome: risk factors, diagnosis and treatment. The Pharmaceutical Journal. [online] Available at: https://pharmaceutical-journal.com/article/ld/acute-coronary-syndrome-risk-factors-diagnosis-and-treatment. The Pharmaceutical JournalLife in the Fast Lane (LITFL), 2021. Acute coronary syndromes. [online] Available at: https://litfl.com/acute-coronary-syndromes/. Life in the Fast Lane • LITFLDisclaimer: Please remember this podcast and all content from Rhesus Medicine is for educational and entertainment purposes only and is not a guide to diagnose or to treat any form of condition. The content is not to be used to guide clinical practice and is not medical advice. Please consult a healthcare professional for medical advice.

An EMS medic, an MVA, a STEMI, a stroke—and everyone's still playing “telephone” with the hospital. In this episode of EMS World Podcasts, host Mike McCabe sits down with Mitch Scott, Solutions Architect at General Devices, to tackle one of EMS's biggest headaches: communication and coordination with the emergency department and specialty teams. Scott breaks down how GD's e-Bridge platform lets crews securely send photos, EKGs, videos, and patient data straight from the field to the ED, cath lab, stroke team, transfer centers, and more—all in one HIPAA-compliant app that never stores images on personal devices. They dig into real-world pain points: long wall times, “we never got your call,” lack of accountability, rural agencies with hour-long transports, and busy EDs juggling multiple priorities. You'll hear how features like GPS tracking, acknowledgement alerts, and detailed timestamps create a defensible QA/QI trail and give everyone—from medics to cardiologists—a shared, real-time view of the patient before they hit the door. If you've ever felt unheard on the radio or wished you could “show, not tell” your next handoff, this episode is for you.  

Ja, der Titel hat nichts mit dem Inhalt zu tun aber so fühlt sich Timo heute... verrotzt bis hinter Meppen!Es gibt einen Nachtrag zur Therapie des STEMI mit Heparin auch bei frischer Hirnblutung und Amyloidangiopathie. Wir sprechen über die Höhenerkrankung: ihr erfahrt die Entstehung, die Symptome und wie man sie verhindert. Es gibt eine Email zum Thema Medizinstudium und dem TMS.Hinterher sprechen wir über das Herzpflaster der Uni Göttingen und Lübeck und was das für Patienten mit chronischem Herzversagen bedeuten kann!Und es gibt einen Nachtrag zum Thema COVID Impfungen 2026 - hier bei Schwangeren und die Empfehlungen dazu.  Timos Song bei Spotify:⁠https://open.spotify.com/intl-de/album/05V3lQXxyXEO7KBD7Bmh1i?si=xy5ml_7oRNucYhJYlVCvSw⁠Wenn ihr Teil unseres Podcasts sein wollt: schreibt eine Email an info@mtma.tv und erzählt uns eure Geschichte, stellt medizinische Fragen, verteilt Lob und oder auch Kritik! Wir freuen uns auf euch! Hier geht es zur Community-Playlist bei Spotify:https://open.spotify.com/playlist/1KZZslxsXeithkNgG4iiPZ?si=30c56287204846eaAn dieser Stelle noch einmal ein fetter Dank an unsere Patreonunterstützer:Bene, Stephi, Sibylle, Fabian, Kirsten, Christian, Lisa-Marie, Johannes, Nele, Franziska, Jule, Katrin, Alessa, Nina, Hendrik, Luke und Doro!

Witam Państwa, nazywam się Jarosław Drożdż, pracuję w Centralnym Szpitalu Klinicznym Uniwersytetu Medycznego w Łodzi, skąd nagrywam podcast Kardio Know-How. W tym odcinku omawiam pojęcie SMuRFs-less. Coraz więcej pojawia się skrótów opisujących szczególne fenotypy choroby niedokrwiennej serca, począwszy od MINOCA i INOCA, a także ANOCA, które omawiałem szerzej w odcinku 117 z 12 maja 2023 roku: https://open.spotify.com/episode/37HPbmamx5qiDVN8fUdhth?si=881fb4ec4a9143cb. Niedługo potem, 24 maja 2023 roku, w podcaście Heart ukazała się rozmowa na ten temat, choć bez użycia terminu ANOCA, lecz z rzetelnym omówieniem MINOCA i INOCA: https://open.spotify.com/episode/57BS26FP3UGH0vnb18xasn?si=4e763c576cde47bf. Dziś jednak do słownika dołącza kolejny ważny skrót – SMuRFs-less – określający pacjentów z zawałem serca i ze zwężeniami tętnic wieńcowych, ale pozbawionych klasycznych, modyfikowalnych czynników ryzyka, co opisano po raz pierwszy w JACC we 09/2023: https://www.jacc.org/doi/10.1016/j.jacc.2023.06.045. Rok później ukazała się analiza NMR pacjentów po zawale, w której po raz pierwszy pojawiło się samo pojęcie SMuRFs-less: https://www.ejinme.com/article/S0953-6205(23)00297-2/fulltext. Ogromny rezonans wywołał także znakomity tekst Paula Ridkera „SMuRF-less but inflamed”, opublikowany podczas Kongresu ESC, który jednoznacznie łączy zawał bez czynników ryzyka ze stanem zapalnym i podkreśla znaczenie hsCRP: https://academic.oup.com/eurheartj/advance-article-abstract/doi/10.1093/eurheartj/ehaf658/8242429?redirectedFrom=fulltext. Problem SMuRFs-less okazał się klinicznie doniosły – obejmuje ok. 11% wszystkich pacjentów z OZW i ponad 20% chorych ze STEMI, co w Polsce w 2024 roku przełożyło się na ok. 11 tysięcy takich przypadków, zgodnie z danymi z naszej publikacji w Polish Heart Journal: https://journals.viamedica.pl/polish_heart_journal/article/view/108435. Pacjenci ci mają wyższe ryzyko wczesnej śmiertelności, częściej doświadczają zatrzymania krążenia, wstrząsu kardiogennego i powikłań okołozabiegowych, a jednocześnie częściej brakuje u nich tradycyjnych czynników ryzyka, za to częściej występują te nietradycyjne, jak choroby zapalne, obciążenia rodzinne czy zaburzenia psychiczne. Leczenie tych chorych okazuje się mniej zgodne z zaleceniami – rzadziej otrzymują statyny, ACE-I, β-blokery czy leki przeciwpłytkowe – dlatego poprawa rokowania zaczyna się od poprawy terapii, w tym intensyfikacji statyn i zwiększenia stosowania pełnego GDMT. Kluczową rolę w ocenie ryzyka odgrywają trzy markery: LDL-C, hsCRP i LP(a), z których każdy niezależnie przewiduje ryzyko zawału, choć aktualne skale ryzyka uwzględniają jedynie LDL-C, dlatego konieczne jest ich uzupełnienie o hsCRP>3 i LP(a)>30. Wreszcie, coraz większego znaczenia nabiera koncepcja zapalna zawału serca, obejmująca zarówno intensywną kontrolę stanu zapalnego – od leczenia infekcji i dbałości o styl życia, po potencjalne terapie przeciwzapalne w rodzaju kolchicyny czy IL-1β-inhibitorów – jak i pełną modyfikację skal ryzyka, bo pacjent SMuRFs-less, pozbawiony tradycyjnych czynników, ma w pierwszym roku prawie dwukrotnie wyższe ryzyko zgonu niż ten klasyczny, palący tytoń czy z hiperlipidemią. Szczegółowy TRANSKRYPT do odcinka.Podcast jest przeznaczony wyłącznie dla osób z profesjonalnym wykształceniem medycznym.

In dieser Folge nehmen wir euch mit in eine Reihe Einsätze, die selbst für uns nach vielen Jahren im Rettungsdienst noch Überraschungen bereithalten. Von einem klassischen STEMI, bei dem unsere Azubis komplett glänzen, über eine heftige Nikotinintox durch Snooze bis hin zu einer echten Kussmaul-Atmung – es war alles dabei. Wir sprechen über Situationen, die ihr so wahrscheinlich noch nie gehört habt: Wie schnell Azubis ein komplettes CRM-Setting rocken können Warum Snus extrem gefährlich werden kann Wie eine 25-Jährige mit Sprachstörung fast wie ein Apoplex wirkt Und warum Kussmaul-Atmung in der Realität komplett anders aussieht als im Lehrbuch Natürlich beantworten wir auch eure Hörerfragen zu Angst, Stress, Kommunikation, Schul-Sanitätsdiensten, Seitenlage-Mythen und vielem mehr.

Links & ResourcesFollow us on social media for updates: ⁠⁠Instagram⁠⁠ | ⁠⁠YouTube⁠⁠Check out our recommended tool: ⁠⁠Prop Stream⁠⁠Thank you for listening!

Listener feedback on non-culprit PCI in STEMI, a major cardiac result in patients on hemodialysis, news on GLP-1 agonists, a dubious stroke trial, and an AHA preview are the topics John Mandrola, MD, discusses 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 Listener Feedback Meta-analysis of MI as a surrogate https://pubmed.ncbi.nlm.nih.gov/34694318/ Compare Acute Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1701067 DANAMI-3–PRIMULTI 10.1016/S0140-6736(15)60648-1 External Link CULPRIT-SHOCK https://www.nejm.org/doi/full/10.1056/NEJMoa1710261   II  Huge Cardiac News for Patients with ESRD PISCES article EMBARGOED Till 1130 AM EST PISCES Trial www.nejm.org/doi/full/10.1056/NEJMoa2513032 REDUCE-IT Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1812792 STRENGTH Trial https://jamanetwork.com/journals/jama/fullarticle/2773120 FISH trial https://jamanetwork.com/journals/jama/fullarticle/1150094 III Obesity Agents White House announces deal with Lilly and Novo on GLP-1 drugs https://www.reuters.com/business/healthcare-pharmaceuticals/novo-lilly-shares-rise-trump-obesity-drug-deal-nears-2025-11-06/ Amylin Agonists Amylin Analog Eloralintide Reduces Weight in Phase 2 Trial https://www.medscape.com/viewarticle/amylin-analog-eloralintide-reduces-weight-phase-2-trial-2025a1000uqf Eloralintide Phase 2 Study https://doi.org/10.1016/S0140-6736(25)02155-5 GLP-1 Comparisons SURMOUNT-5 Trial https://www.nejm.org/doi/10.1056/NEJMoa2416394 Tirzepatide vs Semaglutide in 10-year CVD Risk Reduction https://doi.org/10.1093/ehjopen/oeaf117 IV A Problematic Trial in Stroke Care LAMP trial https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2840370 V AHA Preview AHA 2025: Mandrola's Four Trials to Look For https://www.medscape.com/viewarticle/aha-2025-mandrolas-four-trials-look-2025a1000u80 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

OPTION-STEMI: Timing of Complete Revascularization During Index Hospitalization in Patients with STEMI and Multivessel Disease

Abdullah Al-Abcha, MD, social media editor of JACC: Cardiovascular Interventions, and Robert Herman, MD, PhD discuss AI-Enabled ECG Analysis Improves Diagnostic Accuracy and Reduces False STEMI Activations: A Multicenter U.S. Registry, presented as a Late Breaking Clinical Trial at TCT 2025.

Review the chain of survival for cardiac and stroke emergencies and describe why strong EMS relations and specialized teams have better patient outcomes.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.**American Cancer Society (ACS) Fundraiser This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.I hope you'll consider contributing.Every donation makes a difference in the fight against breast cancer! Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylorTHANK YOU for your support! Good luck with your ACLS class!Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/savePass ACLS Web Site - Other ACLS-related resources: https://passacls.com@Pass-ACLS-Podcast on LinkedIn

Links & ResourcesFollow us on social media for updates: ⁠⁠Instagram⁠⁠ | ⁠⁠YouTube⁠⁠Check out our recommended tool: ⁠⁠Prop Stream⁠⁠Thank you for listening!

Prehospital EMS capabilities and why paramedic-staffed ALS ambulances make a difference in the early identification & treatment of STEMI and stroke.The chain of survival for a cardiac emergency and stroke.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.**American Cancer Society (ACS) Fundraiser This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.I hope you'll consider contributing.Every donation makes a difference in the fight against breast cancer! Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylorTHANK YOU for your support! Good luck with your ACLS class!Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/savePass ACLS Web Site - Other ACLS-related resources: https://passacls.com@Pass-ACLS-Podcast on LinkedIn

Chief nursing officer Rhonda Collins discusses her article "Nurse-initiated protocols for sepsis: a strategic imperative for patient care and hospital operations." Rhonda explains why sepsis, the leading cause of death in U.S. hospitals and a $62 billion annual burden, demands the same urgency as stroke and STEMI. She highlights the power of nurse-initiated standing orders to speed recognition and treatment, reduce ED congestion, improve outcomes and cut costs. Drawing on real-world results from Franciscan Missionaries of Our Lady Health System, she shows how standardized sepsis protocols supported by FDA-cleared technology reduced mortality by 39 percent, shortened length of stay and saved thousands per patient. Rhonda emphasizes that national standardization, objective tools and empowering nurses to practice at the top of their license are essential to making sepsis the "third S" in emergency care. Our presenting sponsor is Microsoft Dragon Copilot. Microsoft Dragon Copilot, your AI assistant for clinical workflow, is transforming how clinicians work. Now you can streamline and customize documentation, surface information right at the point of care, and automate tasks with just a click. Part of Microsoft Cloud for Healthcare, Dragon Copilot offers an extensible AI workspace and a single, integrated platform to help unlock new levels of efficiency. Plus, it's backed by a proven track record and decades of clinical expertise, and it's built on a foundation of trust. It's time to ease your administrative burdens and stay focused on what matters most with Dragon Copilot, your AI assistant for clinical workflow. VISIT SPONSOR → https://aka.ms/kevinmd SUBSCRIBE TO THE PODCAST → https://www.kevinmd.com/podcast RECOMMENDED BY KEVINMD → https://www.kevinmd.com/recommended

Happy September! This month for the September 2025 episode of the RCEM Learning Podcast Andy and Dave are talking about AI interpretation of ECG findings and managing acute asthma exacerbations. We are then going back to Becky and Chris rounding off the second part of their guideline on atrial fibrillation. We'll then end with New Online. If you'd like to email us, please feel free to do so here. After listening, complete a short quiz to have your time accredited for CPD at the RCEMLearning website! (02:13) New in EM - AI vs doctor in cath lab activations Accuracy of cath lab activation decisions for STEMI-equivalent and mimic ECGs: Physicians vs. AI (Queen of Hearts by PMcardio) (Shroyer et al., 2025) (18:00) Guidelines for EM - ESC Atrial Fibrillation (Part Two) ESC - 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS) (ESC, 2024) (39:03) New in EM - Management of acute asthma exacerbations As-Needed Albuterol–Budesonide in Mild Asthma (LaForce et al., 2025) Combination fixed‐dose beta agonist and steroid inhaler as required for adults or children with mild asthma (Cochrane Library, 2021) (54:00) New Online – new articles on RCEMLearning for your CPD Understanding Medical Cannabis: Mechanisms, Indications and Clinical Integration - David Tang Safe Sedation Procedures in Adults - Duncan Russell and Shobhan B Thakore Unusual Agitation in Final Year Student - Cathy Wield and Mark Horowitz

King and I | S6 E3 | Should EKG be the Discriminator for STEMI

The JournalFeed podcast for the week of Sept 1-5, 2025.These are summaries from just 2 of the 5 articles we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.Tuesday Spoon Feed:The Queen of Hearts AI (QoH AI) model beat both emergency physicians (EPs) and cardiologists at deciding who needs immediate catheterization for certain STEMI-equivalents and STEMI-mimics—88.9% accuracy vs. ~66%—promising fewer missed occlusion myocardial infarctions (OMIs) and fewer unnecessary activations.Wednesday Spoon Feed:Reliance on STEMI criteria alone misses a substantial proportion of LAD occlusions, while expert and AI ECG interpretation achieved earlier and more accurate detection, with 100% sensitivity for LAD occlusion MI in this study.

We talk about stat vs routine EKG orders as well as metrics that they are always working to hit on timeWhen EKG's are not done on time the source of the problem needs to be found, sometimes it is the providers' fault for not realizing the EKG order had not been placed We talk about how we should communicate between provider and EKG tech and how much info we like to get as providersI talk about how providers need to become good at task switching frequently and this includes signing EKG'sWe talk about the responsibility of the PA or NP to sign EKG's (calling STEMI's or deciding not a STEMI) and how this responsibility is currently in the hands of the physicians onlySean talks about how important EKG's can still fall through the cracks at times and people will still point the blame all the way back to the EKG techIt's important to make sure you do your job well and then realize some things are out of your handsCheyenne talks about an experience she had with an end-of-life patient she cared forEven being just peripherally involved in a patient's care can really affect you emotionallyAvoiding burnout:Cheyenne likes to go to the gym or hang out at home with her dogsSean talks about how he avoids burnout doing a job that can sometimes be repetitiveSean also talks about the importance of calmness in front of patients, even when an EKG might be alarmingDon't sweat the small things, especially in the ED, everyone is under a lot of stress, and you can't allow a small comment from a stressed-out coworker to get under your skin and make you spiral Sean talks about some methods to reassure patients despite not being able to diagnose their EKG We talk about the importance of stress management in the ED so that you can think clearly about the next patientIt is not your emergency, we must be the calm in the stormSupport the showFull show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, ParamedicsMost efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

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.**American Cancer Society (ACS) Fundraiser This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.I hope you'll consider contributing.Every donation makes a difference in the fight against breast cancer! Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylorTHANK YOU for your support! Good luck with your ACLS class!Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/savePass ACLS Web Site - Other ACLS-related resources: https://passacls.com@Pass-ACLS-Podcast on LinkedIn

Felix Lindberg, MD, PhD and Abdullah Al-Abcha, MD discuss revascularization strategies in ST-elevation myocardial infarction with multivessel disease - temporal trends, patient profiles, and outcomes.

Felix Lindberg, MD, PhD and Abdullah Al-Abcha, MD discuss revascularization strategies in ST-elevation myocardial infarction with multivessel disease - temporal trends, patient profiles, and outcomes.

One unstable patient, three departments, and every nurse on alert... Let's break down what really happens during a high-risk STEMI. This episode follows the case of a 62-year old patient from ER to the Cath Lab to the ICU. Nurses Sarah Vance and Caitlyn Nichols help us explore the role of nurses in each stage of care, from stabilizing the patient to placing an Impella device.We cover everything from IV placement and medications to monitoring patients through each phase of care. Learn how to prepare patients for the Cath Lab, manage complications like V-fib and bleeding post-PCI, and support the next team during handoffs. This is a must-listen for nurses involved in cardiac care!Topics discussed in this episode:Case presentation of a 62-year old patientER nurse priorities for STEMI patientsInitial treatment and stabilizationWhy “M.O.N.A.” is an outdated practicePreparing the patient for the Cath Lab teamCath Lab nurse responsibilities and role during PCIHigh-risk PCI vs. standard PCIManaging common complicationsTransitioning from Cath Lab to ICUICU nurse priorities for post-PCI patientsImpella placement and monitoringManaging reperfusion arrhythmiasLong-term care and getting patients off the ImpellaPatient and family educationConnect with Sarah Vance:https://www.instagram.com/iseeu_nurse/Connect with Caitlyn Nichols:https://www.instagram.com/icunursingnotesbycaitlyn/Mentioned in this episode:CONNECT

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; and4. 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.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.vipPass ACLS Web Site - Episode archives & other ACLS-related podcasts: https://passacls.com@Pass-ACLS-Podcast on LinkedIn 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.

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on Stent-Retriever Thrombectomy in STEMI With Large Thrombus Burden: The RETRIEVE AMI Randomized Trial.

In this JACC Deep Dive, Harlan M. Krumholz, MD, SM, FACC reviews a study by Covani, et al that uses OCT imaging in over 1,500 ACS patients to show how increasing cardiovascular risk factor burden—like smoking, diabetes, and hypertension—is strongly associated with vulnerable plaque features such as thin caps, inflammation, and rupture. The findings were most pronounced in STEMI patients and reinforce the biological impact of cumulative risk. Reviewers found the core results intuitive but pushed for deeper mechanistic insights, leading to a stronger final paper with improved clarity, additional analyses, and a more nuanced understanding of how traditional risk factors shape plaque instability.

New Insights from the DanGer Shock Trial!

The TCTMD news team share their h, from troponin spikes in exercise to GLP-1s in PAD, STEMI delays, and the legacy of Dimitrios Karmpaliotis.

Hosts Mitsuaki Sawano, MD, Kentaro Ejiri, MD, and Nobuhiro Ikemura, MD, welcome Yuki Obayashi, MD, of Leiden University Medical Center, to discuss findings from the STOPDAPT-3 trial. Dr. Obayashi highlights that, among ACS patients—including those with HBR or STEMI—aspirin and clopidogrel monotherapy after 1 month of DAPT resulted in similar rates of ischemic and bleeding events. These results support flexible, patient-centered antiplatelet strategies beyond the acute phase.

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/Free Prescription Discount Card - Download your 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

In Episode #39 of EM Logic, Dr. Pregerson discusses occlusion MIs (OMI) that are missed by STEMI criteria. One-fourth to one-third of NSTEMIs are actually missed acute coronary occlusions, which would be best treated with emergent reperfusion. Read more details here in the Show Notes.

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; and4. 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.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.vipPass ACLS Web Site - Episode archives & other ACLS-related podcasts: https://passacls.com@Pass-ACLS-Podcast on LinkedIn

In this webinar, the CardioNerds collaborated with the Cardiogenic Shock Working Group (CSWG) to discuss LV unloading and the updated AMI guidelines, which upgraded transvalvular flow pumps to a Class 2A recommendation in AMI shock. Dr. Rachel Goodman and Dr. Gurleen Kaur from CardioNerds were joined by Dr. Navin Kapur (Tufts Medical Center), Dr. Shashank Sinha (INOVA Fairfax Hospital), and Dr. Rachna Kataria (Brown University) from the CSWG. Together, they explore a case of an older woman who presented with inferior STEMI and was found to have complete occlusion of an anomalous single coronary artery originating from the right coronary cusp and supplying the entire left ventricle. She was treated with DES to the anomalous RCA. Her course was complicated by AMI shock with re-occlusion of the DES, which was treated with thrombectomy and balloon angioplasty. An IABP was placed. After transfer to a tertiary care center, a pulmonary artery catheter revealed a CI of 0.96. With worsening shock, rising lactate, and end organ dysfunction, the team proceeded with VA-ECMO and Impella CP for LV unloading. Her lactate subsequently normalized. Produced by CardioNerds in collaboration with the Cardiogenic Shock Working Group. CardioNerds Cardiac Critical Care PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron!

This week on the Inside EMS podcast, hosts Chris Cebollero and Kelly Grayson tackle a metabolic monster that every EMS provider needs to master: diabetic ketoacidosis (DKA). They kick off with a common (but critical) 911 scenario: a 19-year-old with a history of Type 1 diabetes, confusion, vomiting and a blood sugar of 500. Sound familiar? Kelly dives into the physiology of DKA, explaining how glucose can be sky-high while cells starve, triggering fat breakdown and ketone production that spirals into life-threatening acidosis. The hosts hit the must-know pathophysiology, signs and symptoms (hello, Kussmaul breathing!), and what providers often miss — like dehydration, vomiting and abdominal pain. They break down how to spot DKA with capnography and EKG changes, especially when hyperkalemia mimics a STEMI. From EMS management tips (don't shut down those fast respirations!) to fluid resuscitation caveats, this is a crash course in saving DKA patients before they crash. Whether you're running calls or managing chronic patients, this episode arms you with the clinical know-how and common-sense insight to handle DKA with confidence. Memorable quotes  “We're starting to see more increasing calls for type one diabetes, insulin-dependent type two diabetes ... and we need to be able to understand what we're doing. — Chris Cebollero “One of the big clues in the scenario is the vomiting. Lots of DKA patients will have vomiting and abdominal pain.” — Kelly Grayson “A lot of times, these hyperkalemia patients and these acidotic patients are going to be handled just fine by correcting their fluid deficits and correcting their glucose with an insulin drip. Just getting their glucose back down to normal level is going to manage the lion's share of the hyperkalemia.” — Kelly Grayson Enjoying the show? Email theshow@ems1.com to suggest episode ideas or to pitch someone as a guest!

The JournalFeed podcast for the week of April 21-25, 2025.These are summaries from just 2 of the 5 articles we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.Wednesday Spoon Feed:This preplanned subgroup analysis of the TOMAHAWK Trial of patients with ROSC after OHCA found no EKG findings (excluding STEMI) that predicted the presence of coronary artery lesions.Thursday Spoon Feed:In this substudy of the Canadian TIA Score cohort, researchers found score utilization with subsequent MRI imaging could improve the outcome of patients suffering from TIA or stroke, particularly in the medium-risk category, scoring between 4-8 points.

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

In Episode #37 of EM Logic, Dr. Pregerson discusses a paper by Dr. Stephen W. Smith on hyperacute T-waves. STEMI misses 30% to 40% of acute coronary occlusions that would benefit from emergent revascularization. Read more details here in the Show Notes. 

Rapid response nurses don't just handle codes — they help prevent them from happening. Contrary to popular belief, Rapid Response Nursing is not just sprinting from code blue the next and neither is ER nursing. While there are a lot of similarities between these two specialties in Nursing, there are a lot of differences too. In this episode, Aidan RN shares what it was like to transition from the fast-paced ER to the world of rapid response.We discuss what sets rapid response apart, the mindset shifts that helped him make the switch, and break down cases where their quick action made all the difference — including a subdural hematoma caught just in time, a STEMI with an unusual presentation, and a patient whose only symptom was neck pain.Whether you're calling rapid response or considering the role yourself, don't miss this conversation on the skills and challenges that define rapid response nursing!Topics discussed in this episode:Why transition from ER to rapid response?Differences between ER and rapid response nursingCase study: discovering a subdural hematomaThe role of intuition in rapid response nursingBest practices to work with rapid response nursesAdvice to nurses considering Rapid Response NursingLearn more about what it's like to be a Rapid Response Nurse!https://www.aacn.org/blog/exploring-the-world-of-rapid-response-nursesMentioned in this episode:CONNECT

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,

" I remember I was working a morning shift and it was 7 or 730 and I remember exactly where I am because I have a special memory and I was in between these two rooms. One had a STEMI and I was trying to get him to the cath lab, the other had a stroke I was trying to administer tpa and I get a phone call and the nanny is calling out."This episode is with Dr. Camie Sorenson who is an Emergency Medicine physician in Fresno, California. In this episode we talk about:- Meeting her husband and the decision not to factor in where he was living when she made her rank list- Making a long distance relationship work- Infertility and how she thinks her job contributed to this- How she managed to undergo fertility treatments- Being the first woman at her job to take maternity leave- Going on to have 4 children and what that looks like today now that they are a little older- Quitting her job when it wasn't working for her- Advocating for yourself and knowing your worthand so much more! Connect with Moms of Medicine:- Instagram @moms_of_medicine- Momsofmedicine@gmail.com

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

Chest pain? Check. Sus ECG? Check. STEMI? Not check. A very tired Chris and a nerded out Spencer (12-leads... go figure) give MAXIMUM effort in today's call with a curious conclusion.

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

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

We often discuss "one in a million" and "once in a career" cases in emergency medicine and EMS, and do we ever have one of those for you in this episode! MCHD Captain, Jason Jones, joins Dr. Patrick to discuss an exeedingly rare STEMI/chest pain presentation with lessons that we can all apply to our daily care. REFERENCES 1. https://www.mchd-tx.org/wp-content/uploads/2025/02/SITUS-Fig-1.pdf 2. https://www.mchd-tx.org/wp-content/uploads/2025/02/SITUS-Fig-2.pdf 3. https://montgomerycountypolicereporter.com/mchd-celebrates-survival-of-one-in-a-million-patient-first-responders-please-read/ 4. https://pubmed.ncbi.nlm.nih.gov/34317454/