Re-engineering the clinical approach to suspected cardiac chest pain assessment in the emergency department by expediting research evidence to practice using artficial intelligence. (RAPIDx AI) - a cluster randomised study design.

Background: Clinical work-up for suspected cardiac chest pain is resource intensive. Despite expectations, high-sensitivity cardiac troponin assays have not made decision making easier. The impact of recently validated rapid triage protocols including the 0-hour/1-hour hs-cTn protocols on care and outcomes may be limited by the heterogeneity in interpretation of troponin profiles by clinicians.

Prognostic Implications of Machine Learning Algorithm-Supported Diagnostic Classification of Myocardial Injury Using the Fourth Universal Definition of Myocardial Infarction.

Background: With widespread adoption of high-sensitivity troponin assays, more individuals with myocardial injury are now identified, with type 1 myocardial infarction (T1MI) being less common despite having the most well-established evidence base to inform care. This study assesses the temporal time course of cardiovascular events among various forms of myocardial injury.

Method: Consecutive hospital encounters were identified.

Economic Outcomes With Precision Diagnostic Testing Versus Usual Testing in Stable Chest Pain: Results From the PRECISE Randomized Trial.

Background: The PRECISE (Prospective Randomized Trial of the Optimal Evaluation of Cardiac Symptoms and Revascularization) demonstrated that a precision diagnostic strategy reduced the primary composite of death, nonfatal myocardial infarction, or catheterization without obstructive coronary artery disease by 65% in patients with nonacute chest pain compared with usual testing. Medical cost was a prespecified secondary end point.

Methods: PRECISE randomized 2103 patients between December 2018 and May 2021 to usual testing or a precision strategy that used deferred testing for the lowest risk patients (20%) and coronary computed tomographic angiography with selective computed tomography-derived fractional flow reserve for the remainder.

Quality of Life Outcomes With a Risk-Based Precision Testing Strategy Versus Usual Testing in Stable Patients With Suspected Coronary Disease: Results From the PRECISE Randomized Trial.

Background: The PRECISE (Prospective Randomized Trial of the Optimal Evaluation of Cardiac Symptoms and Revascularization) trial compared an investigational precision diagnostic testing strategy (n=1057) with usual testing (n=1046) in patients with stable chest pain and suspected coronary artery disease. Quality of life (QOL) outcomes were a prespecified secondary end point.

Methods: We assessed QOL by structured interviews in all trial participants at baseline and 45 days, 6 months, and 12 months postrandomization.

Human-centred AI for emergency cardiac care: Evaluating RAPIDx AI with PROLIFERATE_AI.

Background: Chest pain diagnosis in emergency care is hindered by overlapping cardiac and non-cardiac symptoms, causing diagnostic uncertainty. Artificial Intelligence, such as RAPIDx AI, aims to enhance accuracy through clinical and biochemical data integration, but its adoption relies on addressing usability, explainability, and seamless workflow integration without disrupting care.

Objective: Evaluate RAPIDx AI's integration into clinical workflows, address usability barriers, and optimise its adoption in emergencies.

Integration of Apolipoprotein B into the SCORE2 Framework: Implications for Cardiovascular Risk Prediction.

Aim: To evaluate whether integrating Apolipoprotein B (ApoB) into the SCORE2 cardiovascular risk prediction framework improves its predictive accuracy and clinical applicability within the UK Biobank population.

Method: A 10-year prospective cohort study was conducted with 448,303 UK Biobank participants eligible for SCORE2 calculation. Three approaches were employed: (1) threshold analysis to determine the optimal ApoB cutoff for cardiovascular disease (CVD) risk prediction using Youden's Index, (2) assessment of the synergistic effect of SCORE2 and ApoB through concordant and discordant classifications, and (3) recalibration of the SCORE2 model by incorporating ApoB as an additional predictor.

Transitioning to high-sensitivity troponin: 1-year mortality outcomes in patients with suspected acute coronary syndrome presenting to emergency departments.

Background: Switching from a conventional to a high-sensitivity cardiac troponin (hs-cTn) assay enables detection of smaller amounts of myocardial damage, but the clinical benefit is unclear. We investigated whether switching to a hs-cTnI assay with a sex-specific 99th centile diagnostic threshold was associated with lower 1-year death or new myocardial infarction (MI) in patients with suspected acute coronary syndrome (ACS).

Methods: This pre-post study included nine tertiary hospitals in Australia.

Assessing the Likelihood of Procedural Intubation During Percutaneous Coronary Intervention.

Background: Preprocedural fasting is widely used before percutaneous coronary intervention (PCI). However, the incidence of procedural intubation during PCI is unknown. This study aims to identify the incidence and predictors for procedural intubation during PCI.

Cost-Effectiveness of Semaglutide in Patients With Obesity and Cardiovascular Disease.

Background: Randomized clinical trials have shown that semaglutide is associated with a clinically relevant reduction in body weight and a lower risk of adverse cardiovascular events in those who are overweight or obese with a history of cardiovascular disease but no diabetes. The objective of this study was to assess the cost-effectiveness of semaglutide for this indication.

Methods: A decision analytic Markov model was used to compare the lifetime benefits and costs of semaglutide 2.

Rates of post procedural prophylactic antibiotic use following cardiac implantable electronic device insertion and the impact on surgical site infections in Alberta, Canada.

Background: The necessity of post procedural prophylactic antibiotics following clean surgeries is controversial. While most evidence suggests that there is no benefit from these additional antibiotics and guidelines do not support their use, there is a paucity of evidence as to how often they are still being used and their impact on infection outcomes. The current study assessed the use of prophylactic antibiotics following cardiac implantable electronic device (CIED) implantations in the province of Alberta, and their impact on infection and mortality.

Single high-sensitivity troponin-I for ruling out acute coronary syndrome: a detection limit approach.

Aims: The aim of this study was determine the incidence of major adverse cardiac events within 30 and 365-days among patients discharged from emergency departments (EDs), following a single high-sensitivity cardiac troponin I test result below or close to the limits of detection (LoD).

Methods And Results: Patients ≥20 years old who presented to four EDs from mid-2014 to end-2015, underwent a single high-sensitivity troponin test and were discharged were included. Data from ED presentations, hospital admissions, mortality records, and pathology laboratories were linked and harmonized.

Machine-Learning for Phenotyping and Prognostication of Myocardial Infarction and Injury in Suspected Acute Coronary Syndrome.

Background: Clinical work-up for suspected acute coronary syndrome (ACS) is resource intensive.

Objectives: This study aimed to develop a machine learning model for digitally phenotyping myocardial injury and infarction and predict 30-day events in suspected ACS patients.

Methods: Training and testing data sets, predominantly derived from electronic health records, included suspected ACS patients presenting to 6 and 26 South Australian hospitals, respectively.

Prehospital factors predicting mortality in patients with shock: state-wide linkage study.

Background: Patients with shock treated by emergency medical services (EMS) have high morbidity and mortality. Knowledge of prehospital factors predicting outcomes in patients with shock remains limited. We aimed to describe the prehospital predictors of mortality in patients with non-traumatic shock transported to hospital by EMS.

Sex-Based Outcomes of Dual-Antiplatelet Therapy After Percutaneous Coronary Intervention: A Pairwise and Network Meta-Analysis.

Background: Although dual antiplatelet therapy (DAPT) improves the outcomes of patients undergoing percutaneous coronary intervention (PCI), sex-specific differences in efficacy and safety of DAPT remain unresolved. We compared sex differences for DAPT outcomes and DAPT durations (1-3 months [short-term], 6 months [mid-term], and >12 months [extended] vs. 12 months).

Low-level elevations in high-sensitivity cardiac troponin predict obstructive coronary artery disease and revascularisation in rural patients with non-ST-elevation myocardial infarction referred for coronary angiography.

Rural patients with non-ST-elevation myocardial infarction (NSTEMI) are transferred to metropolitan hospitals for invasive coronary angiography (ICA). Yet, many do not have obstructive coronary artery disease (CAD). In this analysis of rural Western Australian patients transferred for ICA for NSTEMI, low-level elevations in high-sensitivity cardiac troponin (≤5× upper reference limit) were associated with less obstructive CAD and revascularisation.

Navigating the Landscape of Medical Device Advisories: A Special Report From the Canadian Heart Rhythm Society Device Advisory Committee.

Cardiac implantable electronic devices (CIEDs) are often important for regulating cardiac rate and rhythm. Pacemakers and defibrillators are among the top 10 most implanted medical devices, with > 1.5 million devices implanted annually.