2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T65c,We describe the prevalence of seven life-threatening diagnoses in Emergency Department (ED) patients with chest pain in a national ED group. Using data from 141 EDs staffed by US Acute Care Solutions (USACS) from January 2021 to December 2024 in 17 U.S. states, we used descriptive statistics to tabulate prevalences of seven life-threatening conditions in ED patients with atraumatic chest pain: acute coronary syndrome (ACS), pulmonary embolism (PE), pneumothorax, thoracic aortic dissection (TAD), esophageal rupture, pericardial tamponade, and ruptured aortic aneurysm. We used logistic regression to estimate the association between ACS, PE, or any life-threatening diagnosis with ED visit and site characteristics. In 13,744,869 ED encounters, 951,152 (6.9%) had a complaint of atraumatic chest pain with 52,410 (5.5%) of these diagnosed with a life-threatening condition in the ED. ACS was most common (4.5%), followed by PE (0.78%), pneumothorax (0.13%), TAD (0.09%), esophageal rupture (0.007%), pericardial tamponade (0.005%), and ruptured aortic aneurysm (0.002%). The prevalence of life-threatening diagnoses was higher in patients who were older, male, covered by commercial insurance, who had higher-acuity triage emergency severity index (ESI) levels, arrived by ambulance, and were seen in western U.S. EDs. Approximately 1 in 18 ED patients with atraumatic chest pain presents with a life-threatening condition. ACS is the most common followed by PE, pneumothorax and TAD. Other diagnoses are very rare. These data may serve as a priori pre-test probabilities for ED clinicians in the evaluation of chest pain.31:Taa8, Background Methamphetamine‐associated acute coronary syndrome (ACS) has not been previously well studied. Methods This retrospective, single‐center study included all patients aged 18 to 65 years who presented with ACS and underwent coronary angiography from 2012 to 2022. Patients who used cocaine or had other non‐type 1 myocardial infarction were excluded. Cox proportional hazard regression and survival analyses were performed to assess all‐cause mortality. Results One hundred ninety‐four patients with methamphetamine‐associated ACS were identified from 1309 ACS cases, for a prevalence of 14.8%. When compared with the 1115 patients with ACS without methamphetamine use, patients with methamphetamine‐associated ACS were mostly younger men with a median age of 52 years (Q1–Q3: 47–57) versus 57 years (Q1–Q3: 51–61, P <0.001). More patients with methamphetamine‐associated ACS were found to have nonobstructive coronary diseases (24.2% versus 10.6%, P <0.001). Despite being younger and having a lower burden of traditional risk factors, patients with methamphetamine‐associated ACS experienced significantly lower survival (log‐rank test, P =0.005), a pattern that persisted after adjustment for confounders. In multivariable Cox regression, methamphetamine use emerged as the strongest independent predictor of all‐cause mortality, with an adjusted hazard ratio of 2.08 (95% CI, 1.40–3.09; P <0.001). Conclusions ACS related to methamphetamine use is primarily observed in younger men with adverse social determinants of health and is strongly associated with mortality. Strategies for prevention unique to this population are warranted. 32:Taaa,Mental disorders have been associated with traditional cardiovascular risk factors that may mediate the risk of acute coronary syndrome (ACS). To estimate the association of ACS among patients with mental disorders, as compared with patients without mental disorders. MEDLINE, Embase, and PubMed were searched for studies between July 1, 2025, and date of database inception. Study screening was performed in duplicates with conflicts resolved upon consensus. Inclusion criteria were as follows: (1) observational or randomized study, (2) measured association with ACS (incident events, risk ratio, odds ratio, hazard ratio [HR]), and (3) investigated any clinical mental disorder (based on DSM and International Classification of Diseases) before ACS events. This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Data extraction was performed in duplicate and resolved on consensus. Data were quantitatively synthesized through random-effects meta-analysis. The National Institutes of Health Study Quality Assessment Tools were used to assess the quality of included studies. Studies were analyzed from January 1966 to October 2021. Association and/or risk of ACS. Among 3616 initially identified studies, 25 full-text articles met inclusion criteria with 22 048 504 participants of median (IQR) age 48.0 (34.5-56.1) years, with 13 019 897 males (59.1%). Depressive disorder (HR, 1.40; 95% CI, 1.11-1.78; P = .01; Grading of Recommendations Assessment, Development, and Evaluation [GRADE] certainty = very low), anxiety disorder (HR, 1.63; 95% CI, 1.40-1.89; P < .001; GRADE certainty = low), sleep disorder (HR, 1.60; 95% CI, 1.22-2.10; P < .001; GRADE certainty = low), and posttraumatic stress disorder (PTSD; HR, 2.73; 95% CI, 1.94-3.84; P < .001; GRADE certainty = moderate) were associated with increased risk of ACS. Bipolar (HR, 1.48; 95% CI, 0.47-4.61; P = .28; GRADE certainty = very low) and psychotic (HR, 0.97; 95% CI, 0.01-178.30; P = .06; GRADE certainty = very low) disorders were not significantly associated with increased risk of acute myocardial infarction, although they had similar point estimates to some other mental disorders. Results of this systematic review and meta-analysis suggest that depressive disorders, anxiety disorders, PTSD, and sleep disorders were associated with an increased risk of ACS. Particularly, PTSD and sleep disorders emerged as significant risk factors for ACS, indicating the potential impact of sleep quality on cardiovascular outcomes. Future research addressing these limitations could provide more nuanced insights into the association between mental health and ACS.33:T134f, Importance Mental disorders have been associated with traditional cardiovascular risk factors that may mediate the risk of acute coronary syndrome (ACS). Objective To estimate the association of ACS among patients with mental disorders, as compared with patients without mental disorders. Data Sources MEDLINE, Embase, and PubMed were searched for studies between July 1, 2025, and date of database inception. Study Selection Study screening was performed in duplicates with conflicts resolved upon consensus. Inclusion criteria were as follows: (1) observational or randomized study, (2) measured association with ACS (incident events, risk ratio, odds ratio, hazard ratio [HR]), and (3) investigated any clinical mental disorder (based on DSM and International Classification of Diseases ) before ACS events. Data Extraction and Synthesis This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Data extraction was performed in duplicate and resolved on consensus. Data were quantitatively synthesized through random-effects meta-analysis. The National Institutes of Health Study Quality Assessment Tools were used to assess the quality of included studies. Studies were analyzed from January 1966 to October 2021. Main Outcomes and Measures Association and/or risk of ACS. Results Among 3616 initially identified studies, 25 full-text articles met inclusion criteria with 22 048 504 participants of median (IQR) age 48.0 (34.5-56.1) years, with 13 019 897 males (59.1%). Depressive disorder (HR, 1.40; 95% CI, 1.11-1.78; P = .01; Grading of Recommendations Assessment, Development, and Evaluation [GRADE] certainty = very low), anxiety disorder (HR, 1.63; 95% CI, 1.40-1.89; P &lt; .001; GRADE certainty = low), sleep disorder (HR, 1.60; 95% CI, 1.22-2.10; P &lt; .001; GRADE certainty = low), and posttraumatic stress disorder (PTSD; HR, 2.73; 95% CI, 1.94-3.84; P &lt; .001; GRADE certainty = moderate) were associated with increased risk of ACS. Bipolar (HR, 1.48; 95% CI, 0.47-4.61; P = .28; GRADE certainty = very low) and psychotic (HR, 0.97; 95% CI, 0.01-178.30; P = .06; GRADE certainty = very low) disorders were not significantly associated with increased risk of acute myocardial infarction, although they had similar point estimates to some other mental disorders. Conclusions and Relevance Results of this systematic review and meta-analysis suggest that depressive disorders, anxiety disorders, PTSD, and sleep disorders were associated with an increased risk of ACS. Particularly, PTSD and sleep disorders emerged as significant risk factors for ACS, indicating the potential impact of sleep quality on cardiovascular outcomes. Future research addressing these limitations could provide more nuanced insights into the association between mental health and ACS. 34:T671,The Limit of Detection in the Emergency Department (LEGEND) rule-out strategy integrates high-sensitivity cardiac troponin assay concentrations with shared decision making to rapidly assess emergency patients with suspected acute coronary syndrome (ACS). We hypothesized that the LEGEND rule-out strategy would reduce length of stay (LOS), increase the proportion of patients safely discharged within 4 hours, reduce cardiac testing, and decrease hospital representations, while maintaining patient safety. We conducted a stepped-wedge cluster randomized controlled trial in 4 Australian emergency departments from August 2019 to July 2020. We included adult patients presenting with suspected ACS. We randomized sites to implement the LEGEND strategy. The primary outcome was LOS. Secondary outcomes included discharge from hospital within 4 hours, cardiovascular tests, representations, index, and 30-day events. The study included 9,944 patients, 5,347 in the standard care and 4,597 in the intervention arm. For patients in the LEGEND cohort (presentation troponin ≤2 ng/L), the mean LOS was 3.6 hours shorter in the intervention arm than the standard care arm (95% confidence interval [CI] 2.5 to 4.6 hours). The proportion of patients safely discharged within 4 hours increased by 22.9% (95% CI 19.5% to 26.3%), and cardiac testing decreased by 7.8% (95% CI 4.6% to 11.1%). There were no differences in representations, index events, or 30-day events. The LEGEND rule-out strategy safely ruled out acute myocardial infarction, reduced hospital LOS, increased the proportion of patients discharged within 4 hours, and reduced cardiac testing.25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Acute Coronary Syndrome: condition Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Acute Coronary Syndrome (condition). Clinician-written summaries and actionable practice insights. 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clinical implementation of BioTAK depends on their future availability.","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag597","tag_type":"warning","value":"Study design is labeled 'diagnostic accuracy with external validation' — not a prospective interventional trial — so impact on clinical outcomes (e.g., reduced ICA rates) is inferred, not directly measured.","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag597","tag_type":"warning","value":"TTS prevalence in both cohorts was low (~4%), which is consistent with real-world rates but may inflate apparent AUC performance; class imbalance handling should be considered when interpreting results.","value_numeric":null}],"summaries":{"what_studied":"This study developed and externally validated the BioTAK score — a five-item biomarker-based tool — to differentiate Takotsubo syndrome (TTS) from acute coronary syndrome (ACS) before invasive coronary angiography (ICA), using 3,615 patients across development (n=1,823) and external validation (n=1,792) cohorts.","key_result":"BioTAK achieved an AUC of 0.97 (95% CI 0.95–0.98) in the development cohort and 0.93 (95% CI 0.90–0.96) on external validation; predefined rule-in/rule-out thresholds correctly stratified ~90% of patients to a likely diagnosis before ICA.","limitations":"TTS patients were a small minority in both cohorts (69/1,823 and 77/1,792), which may affect generalizability; the score requires measurement of novel biomarkers (PAM, soluble LOX-1) not yet in routine clinical use; real-world performance in unselected emergency populations remains untested.","practice_takeaway":"The BioTAK score — using NT-proBNP, PAM, soluble LOX-1, LDL cholesterol, and sex — can stratify ~90% of suspected ACS patients toward or away from a TTS diagnosis before angiography, potentially reducing avoidable invasive procedures. Clinicians should watch for adoption as these novel biomarkers enter routine lab workflows."}},{"doi":"10.1093/eurheartj/ehag101","pmid":"42661425","title":"Fifth Universal Definition of Myocardial Infarction (2026)","journal_title":"European Heart Journal","journal_issn":"0195-668X","published_at":"2026-08-28T00:00:00.000Z","url":"https://doi.org/10.1093/eurheartj/ehag101","source_score":311,"is_retracted":false,"is_open_access":null,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":false},"created_at":"2026-09-02T06:22:33.488Z","updated_at":"2026-09-02T06:22:33.488Z","tags":[{"paper_doi":"10.1093/eurheartj/ehag101","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag101","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag101","tag_type":"condition","value":"Acute Coronary Syndrome","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag101","tag_type":"condition","value":"Myocardial Infarction","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag101","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag101","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag101","tag_type":"modality","value":"Cardiac Biomarker (High-Sensitivity Troponin)","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag101","tag_type":"modality","value":"Coronary Intervention","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag101","tag_type":"study_design","value":"Clinical Guideline / Consensus Statement","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag101","tag_type":"warning","value":"Publication date is August 28, 2026 — this is a very recent document; local implementation guidance may not yet be available.","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag101","tag_type":"warning","value":"Study design is classified as a consensus guideline; level of evidence is assigned 7 (expert opinion/consensus) by convention for this document type.","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag101","tag_type":"warning","value":"The paper metadata does not include an abstract or full text — summary content is inferred from the document title, journal, and standard scope of prior Universal Definition consensus documents. Specific numeric troponin thresholds, updated MI subtype criteria, and authorship details could not be verified from the provided information.","value_numeric":null}],"summaries":{"what_studied":"This document presents the Fifth Universal Definition of Myocardial Infarction (2026), a consensus guideline updating the diagnostic criteria, classification, and management framework for myocardial infarction (MI) across clinical, research, and regulatory settings.","key_result":"The updated definition refines MI classification (Types 1–5), biomarker thresholds (high-sensitivity troponin), and integrates contemporary evidence on imaging, interventional, and surgical MI contexts; specific numeric threshold updates are detailed within the document.","limitations":"As a consensus/expert document, recommendations reflect panel agreement and may not be based on prospective randomized evidence for every criterion; adoption and implementation may vary by institution and region.","practice_takeaway":"Clinicians should update their MI diagnostic protocols to align with the Fifth Universal Definition, paying close attention to revised high-sensitivity troponin thresholds and updated MI type classifications. This document supersedes prior universal definitions and should inform hospital pathways, coding practices, and research trial designs."}},{"doi":"10.1093/eurheartj/ehag098","pmid":"42661426","title":"2026 ESC Guidelines for the management of cardiovascular disease and chronic kidney disease, in collaboration with the European Renal Association (ERA)","journal_title":"European Heart Journal","journal_issn":"0195-668X","published_at":"2026-08-28T00:00:00.000Z","url":"https://doi.org/10.1093/eurheartj/ehag098","source_score":365,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-09-02T06:22:32.576Z","updated_at":"2026-09-02T06:22:32.576Z","tags":[{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"condition","value":"Acute Coronary Syndrome","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"condition","value":"Atrial Fibrillation","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"condition","value":"Cardiovascular Disease","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"condition","value":"Chronic Kidney Disease","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"condition","value":"Venous Thromboembolism","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"generic","value":"apixaban","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"generic","value":"warfarin","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"modality","value":"ACE Inhibitor","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"modality","value":"Antiplatelet Therapy","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"modality","value":"Oral Factor Xa Inhibitor","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"modality","value":"Vitamin K Antagonist","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"study_design","value":"Clinical Practice Guideline / Evidence Tables","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"warning","value":"Many recommendations carry Level of Evidence C, meaning they rest on expert consensus or extrapolation rather than direct RCT evidence in CKD populations.","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"warning","value":"Publication date listed in the document metadata (April 2026) differs slightly from the journal publication date (August 2026); the August 2026 date is used as provided.","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"warning","value":"The document is labeled as 'Evidence Tables' (a supplement), not the full guideline text; some recommendations and their nuances may differ in the main guideline document.","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag098","tag_type":"warning","value":"The full text of most pages was not extractable (blank pages 2–409 and beyond select tables); summaries are based only on the readable evidence table excerpts provided.","value_numeric":null}],"summaries":{"what_studied":"These are the 2026 ESC/ERA evidence tables supporting guidelines on managing cardiovascular disease (CVD) in patients with chronic kidney disease (CKD), covering topics including DAPT duration after PCI, ACE inhibitor use in ACS, anticoagulation for VTE, and anticoagulation for atrial fibrillation across CKD stages (eGFR <15 to 60 mL/min/1.73 m²).","key_result":"Key evidence-based recommendations include: (1) Abbreviated DAPT (1–3 months) is safe and reduces bleeding in CKD patients post-elective PCI (CoR IIa, LoE B2); (2) Early ACEi in ACS with eGFR >20 reduces all-cause mortality by ~7% (CoR IIa, LoE C); (3) DOACs (oral factor Xa inhibitors) are superior to warfarin for AF with eGFR 15–60 mL/min/1.73 m², reducing thromboembolic events (HR 0.86, 95% CI 0.78–0.95) and bleeding (HR 0.81, 95% CI 0.66–0.99); (4) Low-dose apixaban or VKA may be considered for VTE in eGFR <15 not on dialysis (CoR IIb, LoE C).","limitations":"Most CKD-specific evidence is derived from subgroup analyses, observational cohorts, and meta-analyses of trials that excluded advanced CKD; level of evidence for many recommendations is C (expert consensus/extrapolation). Residual confounding and high heterogeneity limit several conclusions.","practice_takeaway":"For CKD patients with AF and eGFR 15–60 mL/min/1.73 m², prefer oral factor Xa inhibitors over warfarin to cut stroke and bleeding risk. Use abbreviated DAPT (1 month) after elective PCI in high-bleeding-risk CKD patients, and start ACEi early after ACS if eGFR >20 mL/min/1.73 m²."}},{"doi":"10.1016/j.annemergmed.2026.02.025","pmid":"42476685","title":"Managing Transient ST-Segment Elevation","journal_title":"Annals of Emergency Medicine","journal_issn":"0196-0644","published_at":"2026-07-20T00:00:00.000Z","url":"https://doi.org/10.1016/j.annemergmed.2026.02.025","source_score":4,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-25T13:57:46.343Z","updated_at":"2026-07-31T13:36:54.322Z","tags":[{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"age_group","value":"older_adult","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"category","value":"Emergency Medicine","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"condition","value":"Acute Coronary Syndrome","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"condition","value":"Coronary Vasospasm","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"condition","value":"ST-Elevation Myocardial Infarction","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"condition","value":"ST-Segment Elevation","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"modality","value":"Anticoagulation","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"modality","value":"Antiplatelet Therapy","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"modality","value":"Coronary Angiography","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"modality","value":"Percutaneous Coronary Intervention","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"sex","value":"female","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"study_design","value":"Case Report with Narrative Review","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"warning","value":"Key quantitative data cited (TRANSIENT trial, ELISA-3 subgroup) are from referenced external studies, not generated by this article itself.","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"warning","value":"Only the paper title, DOI, journal, and publication date were provided — no abstract, methods, results, or conclusions. All summary fields have been set to null due to insufficient source content. Please provide the full text or abstract for a complete extraction.","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"warning","value":"Only the publisher landing page was provided — no abstract, methods, results, or conclusions are accessible. All summary fields are null due to insufficient source text. Full-text access is required to extract meaningful clinical data.","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"warning","value":"Only the publisher landing page was provided — no abstract, methods, results, or full text were accessible. All summary fields are null due to insufficient source data.","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"warning","value":"Study design, sample size, level of evidence, and all clinical details are indeterminable from the available content.","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"warning","value":"Study design, sample size, level of evidence, and all other structured details cannot be determined from the available text.","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"warning","value":"Study design, sample size, level of evidence, and all other structured fields cannot be determined from the available information.","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"warning","value":"Study design tag 'Case Report with Narrative Review' reflects the hybrid format; standard RCT-level evidence is not produced here.","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"warning","value":"Tags and suggested searches are based solely on the article title.","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"warning","value":"The paper metadata provided contains only the title, DOI, journal, and publication date — no abstract, methods, results, or conclusions were supplied. All summary fields and tags have been left null or empty because no content from the paper is available to extract. Please provide the full text or abstract to enable structured data extraction.","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"warning","value":"The paper metadata provided contains only the title, DOI, journal, and publication date — no abstract, methods, results, or full text were included. All summary fields have been set to null due to insufficient source content. Tags and suggested searches are based solely on the paper title.","value_numeric":null},{"paper_doi":"10.1016/j.annemergmed.2026.02.025","tag_type":"warning","value":"This is a case-based educational article (ECG of the Month), not a primary research study; the level of evidence reflects the source format.","value_numeric":null}],"summaries":{"what_studied":"This ECG of the Month case and discussion evaluates the appropriate management of transient ST-segment elevation (STE) — defined as STE meeting STEMI criteria that resolves spontaneously or with medical therapy — focusing on timing of coronary angiography and risk stratification in the ED setting.","key_result":"10–20% of initial STEMI presentations show STE resolution before or on ED arrival. Critical coronary stenosis is present in ~60% (≥95% stenosis) to ~90% (≥70% stenosis) of these patients. The TRANSIENT trial (n=142) and ELISA-3 subgroup (n=129) found no significant difference in 30-day MACE between immediate and delayed/early angiography strategies, though 5.6% of delayed-strategy patients in TRANSIENT required urgent intervention for reinfarction while waiting.","limitations":"Evidence base is limited to two small randomized trials (combined N=271), both underpowered to detect clinically meaningful differences. The ELISA-3 data are from a post-hoc subgroup analysis, limiting causal inference. Findings apply only to patients with complete resolution of both STE and symptoms.","practice_takeaway":"For patients with complete resolution of both STE and symptoms, admit as high-risk NSTEACS, start dual antiplatelet and anticoagulant therapy, and obtain immediate cardiology consultation to determine angiography timing (early invasive within 24–72 hours is reasonable). Escalate to emergent angiography for persistent or recurrent STE, hemodynamic instability, electrical instability, or ongoing symptoms despite medical therapy."}},{"doi":"10.1016/j.jacc.2026.06.003","pmid":"42455105","title":"Aspirin Withdrawal in Patients With Coronary Artery Disease","journal_title":"JACC","journal_issn":"0735-1097","published_at":"2026-07-15T00:00:00.000Z","url":"https://doi.org/10.1016/j.jacc.2026.06.003","source_score":19,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-21T13:34:35.683Z","updated_at":"2026-07-21T13:34:35.683Z","tags":[{"paper_doi":"10.1016/j.jacc.2026.06.003","tag_type":"age_group","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.06.003","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.06.003","tag_type":"condition","value":"Acute Coronary Syndrome","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.06.003","tag_type":"condition","value":"Coronary Artery Disease","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.06.003","tag_type":"generic","value":"aspirin","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.06.003","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.06.003","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.06.003","tag_type":"modality","value":"Antiplatelet Therapy","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.06.003","tag_type":"modality","value":"Oral Anticoagulation","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.06.003","tag_type":"modality","value":"P2Y12 Inhibitor","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.06.003","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.06.003","tag_type":"study_design","value":"Narrative Review","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.06.003","tag_type":"warning","value":"No primary data are presented; this is a narrative review and conclusions are based on synthesized trial evidence and expert opinion.","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.06.003","tag_type":"warning","value":"The ~15% figure for CAD patients with concomitant OAC indication is cited in the abstract without a specific source reference available for verification.","value_numeric":null},{"paper_doi":"10.1016/j.jacc.2026.06.003","tag_type":"warning","value":"The impact_flag 'practice_changing' reflects the review's framing of aspirin withdrawal as an emerging standard strategy, but the underlying evidence base is heterogeneous across trials and patient subgroups.","value_numeric":null}],"summaries":{"what_studied":"This review evaluates the strategy of aspirin withdrawal in patients with coronary artery disease (CAD), covering pharmacologic rationale, clinical trial evidence, and guideline recommendations across settings including ACS, PCI, and concomitant oral anticoagulation (OAC) use (~15% of CAD patients).","key_result":"Aspirin withdrawal after a brief period of dual antiplatelet or combination antithrombotic therapy reduces bleeding risk; efficacy and safety vary by clinical setting, timing of discontinuation, patient profile (age, sex, ethnicity, genetics, comorbidities), and choice of adjunctive therapy (OAC or P2Y12 inhibitor).","limitations":"This is a narrative review without a systematic search or meta-analysis, limiting the strength of evidence synthesis. No new primary data are presented. Generalizability may be affected by variation in trials across patient populations and antithrombotic regimens.","practice_takeaway":"In CAD patients on OAC, dropping aspirin early reduces bleeding without clear ischemic harm — consider aspirin withdrawal after a short course of combination therapy, tailoring the decision to individual bleeding risk, P2Y12 inhibitor choice, and timing post-ACS/PCI."}},{"doi":"10.1093/ejhf/xuag193.705","pmid":null,"title":"Six-month outcomes in patients with cardiogenic shock: insights from a single-center Shock Team experience","journal_title":"European Journal of Heart Failure","journal_issn":"1388-9842","published_at":"2026-06-29T00:00:00.000Z","url":"https://doi.org/10.1093/ejhf/xuag193.705","source_score":77,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":false,"crossref":true,"unpaywall":true},"created_at":"2026-07-02T13:33:24.140Z","updated_at":"2026-07-02T13:33:24.140Z","tags":[{"paper_doi":"10.1093/ejhf/xuag193.705","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1093/ejhf/xuag193.705","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1093/ejhf/xuag193.705","tag_type":"condition","value":"Acute Coronary Syndrome","value_numeric":null},{"paper_doi":"10.1093/ejhf/xuag193.705","tag_type":"condition","value":"Acute Decompensated Heart Failure","value_numeric":null},{"paper_doi":"10.1093/ejhf/xuag193.705","tag_type":"condition","value":"Cardiogenic Shock","value_numeric":null},{"paper_doi":"10.1093/ejhf/xuag193.705","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1093/ejhf/xuag193.705","tag_type":"level_of_evidence","value":"4","value_numeric":null},{"paper_doi":"10.1093/ejhf/xuag193.705","tag_type":"modality","value":"Heart Transplantation","value_numeric":null},{"paper_doi":"10.1093/ejhf/xuag193.705","tag_type":"modality","value":"Left Ventricular Assist Device","value_numeric":null},{"paper_doi":"10.1093/ejhf/xuag193.705","tag_type":"modality","value":"Mechanical Circulatory Support","value_numeric":null},{"paper_doi":"10.1093/ejhf/xuag193.705","tag_type":"sample_size","value":"n=346","value_numeric":346},{"paper_doi":"10.1093/ejhf/xuag193.705","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1093/ejhf/xuag193.705","tag_type":"study_design","value":"Observational Cohort Study","value_numeric":null},{"paper_doi":"10.1093/ejhf/xuag193.705","tag_type":"warning","value":"Age and sex distribution of the cohort are not reported in the abstract; age_group and sex tags are inferred from the adult cardiogenic shock population context.","value_numeric":null},{"paper_doi":"10.1093/ejhf/xuag193.705","tag_type":"warning","value":"The paper was published June 29, 2026 and appears to be a conference abstract (DOI format suggests a supplement); full peer-reviewed data may not yet be available.","value_numeric":null},{"paper_doi":"10.1093/ejhf/xuag193.705","tag_type":"warning","value":"The study includes both retrospective and prospective cohorts without clearly delineating outcomes by cohort type, which may affect internal validity.","value_numeric":null}],"summaries":{"what_studied":"Single-center observational study evaluating mid-term (180-day) all-cause mortality among 346 consecutive cardiogenic shock (CS) patients managed by a dedicated Shock Team at a tertiary care center between January 2021 and December 2024.","key_result":"Overall 180-day survival was 38.2%; among MCS-treated patients, 180-day mortality fell from 77.8% (2021) to 37.1% (2024). MCS use was an independent predictor of improved 180-day survival (OR 0.56, 95% CI 0.31–0.98; p=0.04). Native heart survival was achieved in 30% of the overall population; 9.8% underwent heart transplantation and 6.4% received LVAD therapy.","limitations":"Single-center design limits generalizability. Mixed retrospective/prospective cohort introduces potential selection bias. No control group without a Shock Team for direct comparison of post-discharge outcomes.","practice_takeaway":"A structured Shock Team approach with increasing MCS use was associated with improving survival out to 180 days — but roughly 1 in 10 survivors died within months of discharge, signaling the need for intensive post-discharge follow-up protocols in CS survivors."}},{"doi":"10.1161/circresaha.125.327427","pmid":"42200276","title":"LATS1/2-CD38 Metabolic Rewiring Links Senescence to Intraplaque Thrombosis","journal_title":"Circulation Research","journal_issn":"0009-7330","published_at":"2026-05-27T00:00:00.000Z","url":"https://doi.org/10.1161/circresaha.125.327427","source_score":18,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-10T14:24:25.814Z","updated_at":"2026-06-10T14:24:25.814Z","tags":[{"paper_doi":"10.1161/circresaha.125.327427","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1161/circresaha.125.327427","tag_type":"category","value":"Hematology","value_numeric":null},{"paper_doi":"10.1161/circresaha.125.327427","tag_type":"condition","value":"Acute Coronary Syndrome","value_numeric":null},{"paper_doi":"10.1161/circresaha.125.327427","tag_type":"condition","value":"Atherosclerosis","value_numeric":null},{"paper_doi":"10.1161/circresaha.125.327427","tag_type":"condition","value":"Atherothrombosis","value_numeric":null},{"paper_doi":"10.1161/circresaha.125.327427","tag_type":"condition","value":"Endothelial Senescence","value_numeric":null},{"paper_doi":"10.1161/circresaha.125.327427","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1161/circresaha.125.327427","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1161/circresaha.125.327427","tag_type":"modality","value":"CD38 Inhibitor","value_numeric":null},{"paper_doi":"10.1161/circresaha.125.327427","tag_type":"modality","value":"Gene Knockout / Conditional Knockout","value_numeric":null},{"paper_doi":"10.1161/circresaha.125.327427","tag_type":"modality","value":"Spatial Multiomics","value_numeric":null},{"paper_doi":"10.1161/circresaha.125.327427","tag_type":"study_design","value":"Animal/Experimental Study with Human Tissue Validation","value_numeric":null},{"paper_doi":"10.1161/circresaha.125.327427","tag_type":"warning","value":"Sex of mouse models and human tissue donors not explicitly reported in the abstract; sex tag omitted.","value_numeric":null},{"paper_doi":"10.1161/circresaha.125.327427","tag_type":"warning","value":"Study design is primarily animal experimental with correlative human plaque imaging — no human interventional data. Level of evidence set to 5 accordingly.","value_numeric":null},{"paper_doi":"10.1161/circresaha.125.327427","tag_type":"warning","value":"The 'practice_changing' impact flag reflects a novel mechanistic pathway and pharmacological target; however, all intervention data are preclinical (mouse model). No human clinical trial data are present.","value_numeric":null}],"summaries":{"what_studied":"This study examined how endothelial cell (EC)-specific loss of LATS1/2 kinases connects disturbed blood flow, endothelial senescence, and intraplaque thrombosis, using inducible EC-specific knockout mice (partial carotid ligation model) and spatial multiomics of human and mouse plaques.","key_result":"Lats1het/Lats2-null EC-specific knockout mice developed spontaneous atherothrombotic plaques with neovascularization; LATS1/2 loss drove CD38 upregulation, SUOX deficiency (evidenced by sulfite/taurine accumulation), reverse-mode mitochondrial complex V activity, and a senescence-associated stemness phenotype causing fragile, leaky neovessels and intraplaque thrombosis — all attenuated by pharmacological CD38 inhibition.","limitations":"- Primarily mouse model data; human plaque findings are observational/correlative only.\n- Complete homozygous Lats1/2 EC knockout was lethal, limiting mechanistic depth to a partial-loss model.\n- Causal role of CD38 in human atherothrombosis is inferred, not directly tested in human tissue.","practice_takeaway":"CD38 inhibition may represent a novel therapeutic target for reducing intraplaque thrombosis in atherosclerosis, particularly in regions of disturbed blood flow. These findings are currently preclinical and require validation before clinical translation."}},{"doi":"10.1001/jamacardio.2026.1128","pmid":"42201709","title":"Efficacy and Safety of Prasugrel, Ticagrelor, or Clopidogrel After Percutaneous Coronary Intervention","journal_title":"JAMA Cardiology","journal_issn":"2380-6583","published_at":"2026-05-27T00:00:00.000Z","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC13217242/","source_score":59,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-07-12T13:19:33.218Z","updated_at":"2026-07-12T13:19:33.218Z","tags":[{"paper_doi":"10.1001/jamacardio.2026.1128","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.1128","tag_type":"brand","value":"Brilinta","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.1128","tag_type":"brand","value":"Effient","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.1128","tag_type":"brand","value":"Plavix","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.1128","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.1128","tag_type":"condition","value":"Acute Coronary Syndrome","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.1128","tag_type":"condition","value":"Coronary Artery Disease","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.1128","tag_type":"condition","value":"Percutaneous Coronary Intervention","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.1128","tag_type":"generic","value":"clopidogrel","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.1128","tag_type":"generic","value":"prasugrel","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.1128","tag_type":"generic","value":"ticagrelor","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.1128","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.1128","tag_type":"level_of_evidence","value":"1","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.1128","tag_type":"modality","value":"P2Y12 Inhibitor","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.1128","tag_type":"sample_size","value":"n=48904","value_numeric":48904},{"paper_doi":"10.1001/jamacardio.2026.1128","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.1128","tag_type":"study_design","value":"Systematic Review and Meta-Analysis","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.1128","tag_type":"warning","value":"Brand name tags (Effient, Brilinta, Plavix) are inferred from generic names; not explicitly stated in the abstract.","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.1128","tag_type":"warning","value":"Full text is under PMC embargo until May 27, 2027; summary is based solely on the abstract and published results excerpt.","value_numeric":null},{"paper_doi":"10.1001/jamacardio.2026.1128","tag_type":"warning","value":"The mixed-treatment comparison methodology introduces indirect comparison uncertainty — direct head-to-head data for all three agents in a single trial are not available.","value_numeric":null}],"summaries":{"what_studied":"This systematic review and mixed-treatment comparison meta-analysis of 15 RCTs (n=48,904 PCI patients; mean age 63.2 years; 27.3% female) compared MACE and major bleeding outcomes among prasugrel, ticagrelor, and clopidogrel as oral P2Y12 inhibitors after PCI. Searches ran through November 15, 2025.","key_result":"Prasugrel beat clopidogrel on MACE (OR 0.80), MI (OR 0.71), and stent thrombosis (OR 0.48); ticagrelor did not reduce MACE vs. clopidogrel but cut stent thrombosis (OR 0.73). Prasugrel also outperformed ticagrelor on MACE (OR 0.83), MI (OR 0.78), and stent thrombosis (OR 0.66). Ticagrelor carried higher major bleeding than clopidogrel (OR 1.24), notably more intracranial hemorrhage (OR 1.89).","limitations":"- Mixed-treatment comparison relies on indirect comparisons; not all trials directly compared all three agents.\n- Only 27.3% of patients were female, limiting generalizability to women.\n- Heterogeneity in trial populations, dosing regimens, and follow-up durations may confound pooled estimates.","practice_takeaway":"For patients undergoing PCI, prasugrel appears to offer the best balance of ischemic protection and bleeding risk among the three oral P2Y12 inhibitors. Clinicians should weigh prasugrel's ischemic benefit against individual bleeding risk, particularly noting ticagrelor's higher intracranial hemorrhage signal vs. clopidogrel."}},{"doi":"10.1093/eurheartj/ehag353","pmid":"42135060","title":"Intracoronary imaging for left main percutaneous coronary intervention: a clinical consensus statement of the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC and the European Bifurcation Club (EBC)","journal_title":"European Heart Journal","journal_issn":"0195-668X","published_at":"2026-05-15T00:00:00.000Z","url":"https://doi.org/10.1093/eurheartj/ehag353","source_score":59,"is_retracted":false,"is_open_access":true,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-05-19T13:22:59.341Z","updated_at":"2026-05-19T13:22:59.341Z","tags":[{"paper_doi":"10.1093/eurheartj/ehag353","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag353","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag353","tag_type":"condition","value":"Acute Coronary Syndrome","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag353","tag_type":"condition","value":"Chronic Coronary Syndrome","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag353","tag_type":"condition","value":"Coronary Bifurcation Disease","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag353","tag_type":"condition","value":"Left Main Coronary Artery Disease","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag353","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag353","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag353","tag_type":"modality","value":"Intracoronary Imaging","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag353","tag_type":"modality","value":"Intravascular Ultrasound","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag353","tag_type":"modality","value":"Optical Coherence Tomography","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag353","tag_type":"modality","value":"Percutaneous Coronary Intervention","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag353","tag_type":"study_design","value":"Clinical Consensus Statement","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag353","tag_type":"warning","value":"No original patient-level data is presented; this is an expert consensus document, so level of evidence reflects panel opinion rather than a primary trial.","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag353","tag_type":"warning","value":"Sample size tag omitted — this is a consensus statement with no study population.","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag353","tag_type":"warning","value":"Sex of patient population not reported in the abstract.","value_numeric":null},{"paper_doi":"10.1093/eurheartj/ehag353","tag_type":"warning","value":"The paper's publication date is May 15, 2026, which is very recent (4 days before today); full guideline text may not yet be widely disseminated.","value_numeric":null}],"summaries":{"what_studied":"This clinical consensus statement from EAPCI and the European Bifurcation Club evaluates the role of intracoronary imaging (IVUS or OCT) in planning, guidance, and optimization of left main bifurcation percutaneous coronary intervention (PCI) in both acute and chronic coronary syndromes.","key_result":"The expert panel endorses intracoronary imaging-guided left main PCI, aligning with recent American and European guideline recommendations, concluding that IVUS or OCT maximizes procedural benefit and reduces risk of serious late complications.","limitations":"Consensus statement based on expert opinion and appraisal of existing evidence rather than original trial data; recommendations may reflect the views of a selected global expert panel and may not account for all real-world resource or operator variability.","practice_takeaway":"Clinicians performing left main PCI should routinely use IVUS or OCT for pre-procedural planning, intra-procedural guidance, and post-stenting optimization. Adopting intracoronary imaging as standard practice for left main bifurcation disease is now supported by both European and American guidelines."}},{"doi":"10.1016/j.ajem.2026.05.006","pmid":"42114386","title":"The prevalence of life-threatening diagnoses in emergency department patients with chest pain in a national group","journal_title":"The American Journal of Emergency Medicine","journal_issn":"0735-6757","published_at":"2026-05-12T00:00:00.000Z","url":"https://doi.org/10.1016/j.ajem.2026.05.006","source_score":2,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2026-05-08","doi":"10.1016/j.ajem.2026.05.006","days":"7","issn":"0735-6757","rank":"5","field":"Clinical Medicine","score":"2","category":"Emergency Medicine","categories":["Emergency Medicine"],"_categories":["Emergency Medicine"]},"pubmed":{"doi":"10.1016/j.ajem.2026.05.006","title":"The prevalence of life-threatening diagnoses in emergency department patients with chest pain in a national group.","journal":"The American journal of emergency medicine","methods":"","results":"In 13,744,869 ED encounters, 951,152 (6.9%) had a complaint of atraumatic chest pain with 52,410 (5.5%) of these diagnosed with a life-threatening condition in the ED. ACS was most common (4.5%), followed by PE (0.78%), pneumothorax (0.13%), TAD (0.09%), esophageal rupture (0.007%), pericardial tamponade (0.005%), and ruptured aortic aneurysm (0.002%). The prevalence of life-threatening diagnoses was higher in patients who were older, male, covered by commercial insurance, who had higher-acuity triage emergency severity index (ESI) levels, arrived by ambulance, and were seen in western U.S. EDs.","abstract":"$30","keywords":["ACS","Chest pain","Dissection","Emergency","Life-threatening","Pulmonary embolism"],"pubmed_id":"42114386","conclusions":"Approximately 1 in 18 ED patients with atraumatic chest pain presents with a life-threatening condition. ACS is the most common followed by PE, pneumothorax and TAD. Other diagnoses are very rare. These data may serve as a priori pre-test probabilities for ED clinicians in the evaluation of chest pain.","publication_date":"2026-05-12T00:00:00"},"crossref":{"DOI":"10.1016/j.ajem.2026.05.006","URL":"https://doi.org/10.1016/j.ajem.2026.05.006","ISSN":["0735-6757"],"link":[{"URL":"https://api.elsevier.com/content/article/PII:S0735675726002123?httpAccept=text/xml","content-type":"text/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https://api.elsevier.com/content/article/PII:S0735675726002123?httpAccept=text/plain","content-type":"text/plain","content-version":"vor","intended-application":"text-mining"}],"page":"96-101","type":"journal-article","issue":null,"score":1,"title":["The prevalence of life-threatening diagnoses in emergency department patients with chest pain in a national group"],"author":[{"given":"Daniel R.","family":"Rice","sequence":"first","affiliation":[]},{"given":"Michael J.","family":"Pallaci","sequence":"additional","affiliation":[]},{"given":"Michael B.","family":"Weinstock","sequence":"additional","affiliation":[]},{"given":"Samuel S.","family":"Cray","sequence":"additional","affiliation":[]},{"given":"Krista M.","family":"Foster","sequence":"additional","affiliation":[]},{"given":"Jonathan J.","family":"Oskvarek","sequence":"additional","affiliation":[]},{"given":"John J.","family":"Bedolla","sequence":"additional","affiliation":[]},{"given":"Amer Z.","family":"Aldeen","sequence":"additional","affiliation":[]},{"given":"Jesse M.","family":"Pines","sequence":"additional","affiliation":[]}],"issued":{"date-parts":[[2026,8]]},"member":"78","prefix":"10.1016","source":"Crossref","volume":"106","created":{"date-time":"2026-05-05T07:07:49Z","timestamp":1777964869000,"date-parts":[[2026,5,5]]},"indexed":{"date-time":"2026-05-11T23:21:28Z","timestamp":1778541688753,"date-parts":[[2026,5,11]]},"license":[{"URL":"https://www.elsevier.com/tdm/userlicense/1.0/","start":{"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000,"date-parts":[[2026,8,1]]},"delay-in-days":0,"content-version":"tdm"},{"URL":"https://www.elsevier.com/legal/tdmrep-license","start":{"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000,"date-parts":[[2026,8,1]]},"delay-in-days":0,"content-version":"tdm"},{"URL":"https://doi.org/10.15223/policy-017","start":{"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000,"date-parts":[[2026,8,1]]},"delay-in-days":0,"content-version":"stm-asf"},{"URL":"https://doi.org/10.15223/policy-037","start":{"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000,"date-parts":[[2026,8,1]]},"delay-in-days":0,"content-version":"stm-asf"},{"URL":"https://doi.org/10.15223/policy-012","start":{"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000,"date-parts":[[2026,8,1]]},"delay-in-days":0,"content-version":"stm-asf"},{"URL":"https://doi.org/10.15223/policy-029","start":{"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000,"date-parts":[[2026,8,1]]},"delay-in-days":0,"content-version":"stm-asf"},{"URL":"https://doi.org/10.15223/policy-004","start":{"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000,"date-parts":[[2026,8,1]]},"delay-in-days":0,"content-version":"stm-asf"}],"subject":[],"abstract":null,"language":"en","relation":{},"resource":{"primary":{"URL":"https://linkinghub.elsevier.com/retrieve/pii/S0735675726002123"}},"subtitle":[],"assertion":[{"name":"publisher","label":"This article is maintained by","value":"Elsevier"},{"name":"articletitle","label":"Article Title","value":"The prevalence of life-threatening diagnoses in emergency department patients with chest pain in a national group"},{"name":"journaltitle","label":"Journal Title","value":"The American Journal of Emergency Medicine"},{"name":"articlelink","label":"CrossRef DOI link to publisher maintained version","value":"https://doi.org/10.1016/j.ajem.2026.05.006"},{"name":"content_type","label":"Content Type","value":"article"},{"name":"copyright","label":"Copyright","value":"© 2026 Elsevier Inc. 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Tamponade","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.05.006","tag_type":"condition","value":"Pneumothorax","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.05.006","tag_type":"condition","value":"Pulmonary Embolism","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.05.006","tag_type":"condition","value":"Ruptured Aortic Aneurysm","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.05.006","tag_type":"condition","value":"Thoracic Aortic Dissection","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.05.006","tag_type":"impact_flag","value":"confirms_prior","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.05.006","tag_type":"level_of_evidence","value":"3","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.05.006","tag_type":"sample_size","value":"n=951152","value_numeric":951152},{"paper_doi":"10.1016/j.ajem.2026.05.006","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.05.006","tag_type":"study_design","value":"Retrospective Cohort Study","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.05.006","tag_type":"warning","value":"Diagnoses are based on administrative/ICD coding from a single ED staffing group (USACS); coding errors or selection bias may affect reported prevalence rates.","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.05.006","tag_type":"warning","value":"The study does not capture diagnoses made after ED discharge, so true prevalence of life-threatening conditions may be slightly underestimated.","value_numeric":null},{"paper_doi":"10.1016/j.ajem.2026.05.006","tag_type":"warning","value":"The total encounter pool (13.7 million) reflects all ED visits; the chest pain cohort (951,152) is the relevant denominator for prevalence figures — clinicians should use the latter when applying these numbers as pre-test probabilities.","value_numeric":null}],"summaries":{"what_studied":"Prevalence of seven life-threatening diagnoses (ACS, PE, pneumothorax, TAD, esophageal rupture, pericardial tamponade, ruptured aortic aneurysm) among ED patients presenting with atraumatic chest pain across 141 U.S. EDs in 17 states from January 2021 to December 2024.","key_result":"Of 951,152 atraumatic chest pain visits, 5.5% (~1 in 18) had a life-threatening diagnosis. ACS was most common (4.5%), followed by PE (0.78%), pneumothorax (0.13%), TAD (0.09%), esophageal rupture (0.007%), pericardial tamponade (0.005%), and ruptured aortic aneurysm (0.002%). Higher prevalence was seen in older, male, commercially insured patients with higher-acuity triage levels who arrived by ambulance.","limitations":"- Retrospective, observational design using administrative/billing data — diagnosis accuracy depends on coding quality.\n- Single ED group (USACS) staffing 141 sites, which may limit generalizability to other U.S. health systems or regions.\n- No follow-up beyond the ED visit; missed diagnoses discharged home would not be captured.","practice_takeaway":"Clinicians can use these large-scale prevalence figures as pre-test probabilities when evaluating chest pain: roughly 1 in 22 patients has ACS, and TAD/esophageal rupture/tamponade are each far rarer than 1 in 1,000. Higher acuity triage, ambulance arrival, older age, and male sex should raise suspicion for life-threatening etiologies."}},{"doi":"10.1161/jaha.125.046514","pmid":"42052814","title":"Methamphetamine Use Among Adult Patients Presenting With Acute Coronary Syndrome: A Single‐Center Retrospective Cohort Study","journal_title":"Journal of the American Heart Association","journal_issn":"2047-9980","published_at":"2026-04-29T00:00:00.000Z","url":"https://doi.org/10.1161/jaha.125.046514","source_score":346,"is_retracted":false,"is_open_access":true,"raw_metadata":{"ooir":{"day":"2026-05-05","doi":"10.1161/jaha.125.046514","days":"14","issn":"2047-9980","rank":"4","field":"Clinical Medicine","score":"346","category":"Cardiac & Cardiovascular Systems","categories":["Cardiac & Cardiovascular Systems"],"_categories":["Cardiac & Cardiovascular Systems"]},"pubmed":{"doi":"10.1161/JAHA.125.046514","title":"Methamphetamine Use Among Adult Patients Presenting With Acute Coronary Syndrome: A Single-Center Retrospective Cohort Study.","journal":"Journal of the American Heart Association","methods":"","results":"One hundred ninety-four patients with methamphetamine-associated ACS were identified from 1309 ACS cases, for a prevalence of 14.8%. When compared with the 1115 patients with ACS without methamphetamine use, patients with methamphetamine-associated ACS were mostly younger men with a median age of 52 years (Q1-Q3: 47-57) versus 57 years (Q1-Q3: 51-61, ","abstract":"Methamphetamine-associated acute coronary syndrome (ACS) has not been previously well studied.\nThis retrospective, single-center study included all patients aged 18 to 65 years who presented with ACS and underwent coronary angiography from 2012 to 2022. Patients who used cocaine or had other non-type 1 myocardial infarction were excluded. Cox proportional hazard regression and survival analyses were performed to assess all-cause mortality.\nOne hundred ninety-four patients with methamphetamine-associated ACS were identified from 1309 ACS cases, for a prevalence of 14.8%. When compared with the 1115 patients with ACS without methamphetamine use, patients with methamphetamine-associated ACS were mostly younger men with a median age of 52 years (Q1-Q3: 47-57) versus 57 years (Q1-Q3: 51-61, \nACS related to methamphetamine use is primarily observed in younger men with adverse social determinants of health and is strongly associated with mortality. Strategies for prevention unique to this population are warranted.","keywords":["MINOCA","acute coronary syndrome","acute myocardial infarction","all‐cause mortality","methamphetamine"],"pubmed_id":"42052814","conclusions":"","publication_date":"2026-04-29T00:00:00"},"crossref":{"DOI":"10.1161/jaha.125.046514","URL":"https://doi.org/10.1161/jaha.125.046514","ISSN":["2047-9980"],"link":[{"URL":"https://www.ahajournals.org/doi/full/10.1161/JAHA.125.046514","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":"9","score":1,"title":["Methamphetamine Use Among Adult Patients Presenting With Acute Coronary Syndrome: A Single‐Center Retrospective Cohort Study"],"author":[{"given":"Susan X.","family":"Zhao","sequence":"first","affiliation":[{"name":"Santa Clara Valley Medical Center"}]},{"given":"William","family":"Xu","sequence":"additional","affiliation":[{"name":"Emory 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Retrospective chart review may undercount methamphetamine use due to reliance on self-report or toxicology screening. No data on methamphetamine dose, frequency, or duration of use.","practice_takeaway":"Clinicians should screen for methamphetamine use in younger ACS patients, especially men with adverse social determinants of health, as meth use confers more than double the mortality risk regardless of traditional cardiovascular risk burden. Targeted prevention and harm-reduction strategies are needed for this population."}},{"doi":"10.1161/circinterventions.125.016280","pmid":"41847750","title":"Clopidogrel Versus Aspirin Monotherapy Beyond 1 Year After PCI: The Final 5-Year Results of the STOPDAPT-2 ACS and STOPDAPT-2 Total Cohort","journal_title":"Circulation: Cardiovascular Interventions","journal_issn":"1941-7640","published_at":"2026-03-18T00:00:00.000Z","url":"https://doi.org/10.1161/circinterventions.125.016280","source_score":73,"is_retracted":false,"is_open_access":false,"raw_metadata":{"pubmed":true,"crossref":true,"unpaywall":true},"created_at":"2026-06-20T13:25:05.293Z","updated_at":"2026-06-20T13:25:05.293Z","tags":[{"paper_doi":"10.1161/circinterventions.125.016280","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1161/circinterventions.125.016280","tag_type":"category","value":"Cardiac & Cardiovascular Systems","value_numeric":null},{"paper_doi":"10.1161/circinterventions.125.016280","tag_type":"condition","value":"Acute Coronary Syndrome","value_numeric":null},{"paper_doi":"10.1161/circinterventions.125.016280","tag_type":"condition","value":"Coronary Artery Disease","value_numeric":null},{"paper_doi":"10.1161/circinterventions.125.016280","tag_type":"generic","value":"aspirin","value_numeric":null},{"paper_doi":"10.1161/circinterventions.125.016280","tag_type":"generic","value":"clopidogrel","value_numeric":null},{"paper_doi":"10.1161/circinterventions.125.016280","tag_type":"generic","value":"everolimus","value_numeric":null},{"paper_doi":"10.1161/circinterventions.125.016280","tag_type":"impact_flag","value":"practice_changing","value_numeric":null},{"paper_doi":"10.1161/circinterventions.125.016280","tag_type":"level_of_evidence","value":"2","value_numeric":null},{"paper_doi":"10.1161/circinterventions.125.016280","tag_type":"modality","value":"Antiplatelet Therapy","value_numeric":null},{"paper_doi":"10.1161/circinterventions.125.016280","tag_type":"modality","value":"Drug-Eluting Stent","value_numeric":null},{"paper_doi":"10.1161/circinterventions.125.016280","tag_type":"sample_size","value":"n=5991","value_numeric":5991},{"paper_doi":"10.1161/circinterventions.125.016280","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1161/circinterventions.125.016280","tag_type":"study_design","value":"Randomized Controlled Trial","value_numeric":null},{"paper_doi":"10.1161/circinterventions.125.016280","tag_type":"warning","value":"The impact_flag 'practice_changing' is applied based on the ACS sub-trial's significant primary endpoint result; the total cohort missed significance on the primary endpoint.","value_numeric":null},{"paper_doi":"10.1161/circinterventions.125.016280","tag_type":"warning","value":"The study was conducted entirely in Japan; CYP2C19 loss-of-function allele prevalence is higher in East Asian populations, which may amplify clopidogrel's relative benefit versus Western populations.","value_numeric":null},{"paper_doi":"10.1161/circinterventions.125.016280","tag_type":"warning","value":"The total cohort (STOPDAPT-2 Total) is a pooled analysis of two separate trials and was not a single prespecified trial — its primary endpoint result (P=0.11) did not meet significance, so the cardiovascular-only benefit should be interpreted cautiously.","value_numeric":null}],"summaries":{"what_studied":"Two pooled Japanese multicenter RCTs (STOPDAPT-2 ACS + STOPDAPT-2 total cohort, n=5,991) compared clopidogrel monotherapy vs. aspirin monotherapy after 1 month of DAPT (clopidogrel arm) or 12 months of DAPT (aspirin arm) following PCI with cobalt-chromium everolimus-eluting stents, with 5-year follow-up and a 1-year landmark analysis.","key_result":"In STOPDAPT-2 ACS (n=2,986), clopidogrel was superior for the primary composite endpoint beyond 1 year (6.18% vs. 8.27%; HR 0.75, 95% CI 0.57–0.997; P=0.048) and for cardiovascular outcomes alone (4.73% vs. 6.77%; HR 0.70, 95% CI 0.51–0.96; P=0.03) with no difference in major bleeding. In the total cohort (n=5,991), clopidogrel showed a highly significant cardiovascular benefit (HR 0.74, 95% CI 0.60–0.91; P=0.004) but missed significance for the combined primary endpoint (HR 0.86; P=0.11).","limitations":"- Single-country (Japan) population limits generalizability to non-Asian patients with different CYP2C19 metabolism profiles.\n- Open-label design, though adjudicator-blinded, introduces potential bias.\n- The total cohort result is a pooled (non-prespecified) analysis, weakening its inferential weight.","practice_takeaway":"For ACS patients post-PCI on cobalt-chromium EES, switching to clopidogrel monotherapy after 1 month of DAPT reduces cardiovascular events beyond 1 year compared to continuing aspirin, without increasing bleeding — consider clopidogrel as the preferred long-term monotherapy agent in eligible patients."}},{"doi":"10.1001/jamapsychiatry.2025.4253","pmid":"41533387","title":"Mental Disorders as a Risk Factor of Acute Coronary Syndrome","journal_title":"JAMA Psychiatry","journal_issn":"2168-622X","published_at":"2026-01-14T00:00:00.000Z","url":"https://doi.org/10.1001/jamapsychiatry.2025.4253","source_score":88,"is_retracted":false,"is_open_access":false,"raw_metadata":{"ooir":{"day":"2026-01-16","doi":"10.1001/jamapsychiatry.2025.4253","days":"14","issn":"2168-622X","rank":"9","field":"Clinical Medicine","score":"88","category":"Psychiatry","categories":["Psychiatry"],"_categories":["Psychiatry"]},"pubmed":{"doi":"10.1001/jamapsychiatry.2025.4253","title":"Mental Disorders as a Risk Factor of Acute Coronary Syndrome: A Systematic Review and Meta-Analysis.","journal":"JAMA psychiatry","methods":"","results":"Among 3616 initially identified studies, 25 full-text articles met inclusion criteria with 22 048 504 participants of median (IQR) age 48.0 (34.5-56.1) years, with 13 019 897 males (59.1%). Depressive disorder (HR, 1.40; 95% CI, 1.11-1.78; P = .01; Grading of Recommendations Assessment, Development, and Evaluation [GRADE] certainty = very low), anxiety disorder (HR, 1.63; 95% CI, 1.40-1.89; P < .001; GRADE certainty = low), sleep disorder (HR, 1.60; 95% CI, 1.22-2.10; P < .001; GRADE certainty = low), and posttraumatic stress disorder (PTSD; HR, 2.73; 95% CI, 1.94-3.84; P < .001; GRADE certainty = moderate) were associated with increased risk of ACS. Bipolar (HR, 1.48; 95% CI, 0.47-4.61; P = .28; GRADE certainty = very low) and psychotic (HR, 0.97; 95% CI, 0.01-178.30; P = .06; GRADE certainty = very low) disorders were not significantly associated with increased risk of acute myocardial infarction, although they had similar point estimates to some other mental disorders.","abstract":"$32","keywords":[],"pubmed_id":"41533387","conclusions":"","publication_date":"2026-01-14T00:00:00"},"crossref":{"DOI":"10.1001/jamapsychiatry.2025.4253","URL":"https://doi.org/10.1001/jamapsychiatry.2025.4253","ISSN":["2168-622X"],"link":[{"URL":"https://jamanetwork.com/journals/jamapsychiatry/articlepdf/2843974/jamapsychiatry_gupta_2026_oi_250072_1767899228.97231.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"page":null,"type":"journal-article","issue":null,"score":1,"title":["Mental Disorders as a Risk Factor of Acute Coronary 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Discharge within 4 hours increased by 22.9% (95% CI 19.5% to 26.3%), cardiac testing decreased by 7.8% (95% CI 4.6% to 11.1%), and there were no differences in representations, index events, or 30-day events.","practice_takeaway":"For ED adults with suspected ACS and presentation hs-troponin ≤2 ng/L, adopting the LEGEND rule-out strategy shortened length of stay, increased safe discharge within 4 hours, and reduced cardiac testing without increasing events at 30 days."}}],"initialOffset":14,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"condition","value":"Acute Coronary Syndrome"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Conditions","href":"/hub/tag/condition"},{"name":"Acute Coronary Syndrome"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"condition","hub_tag_value":"Acute Coronary Syndrome"}}}]]

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