Daily Cardiology Research Analysis

BACKGROUND: The optimal coronary stenting technique for true left main bifurcation lesions is uncertain. EBC MAIN (European Bifurcation Club Left Main Trial) aimed to evaluate clinical outcomes of a stepwise provisional strategy compared with a systematic dual-stent approach. METHODS: EBC MAIN was a randomized, investigator-initiated, open-label, multicenter, parallel-group trial conducted across 35 hospitals in 11 European countries. A total of 467 participants undergoing percutaneous coronary intervention for unprotected true left main bifurcation lesions were randomly assigned to the stepwise provisional strategy (n=230) or an upfront dual-stent approach (n=237). The mean (SD) age was 71 (10) years and 23% of participants were women. The primary end point was a composite of major adverse cardiac events, defined as all-cause mortality, all myocardial infarction, or clinically driven target lesion revascularization. Events were adjudicated by an independent clinical events committee and all analyses were by the intention-to-treat principle. RESULTS: At 3 years, the primary end point occurred in 54 of 230 (23.5%) stepwise provisional and 70 of 237 (29.5%) dual-stent patients (hazard ratio, 0.75 [95% CI, 0.53-1.07]; CONCLUSIONS: In a European population with true left main stem bifurcation coronary disease requiring intervention, there was no difference in major adverse cardiovascular events between stepwise provisional and systematic dual-stent strategies at 3 years. Target lesion revascularization was significantly less frequent with the stepwise provisional approach, which should be the default strategy for noncomplex left main bifurcation coronary intervention. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02497014.

IMPORTANCE: The direct effect of consumption of salt substitutes on recurrent stroke and mortality among patients with stroke remains unclear. OBJECTIVE: To evaluate the effects of salt substitutes vs regular salt on the incidence of recurrent stroke and mortality among patients with stroke. DESIGN, SETTING, AND PARTICIPANTS: The Salt Substitute and Stroke Study (SSaSS), an open-label, cluster randomized clinical trial, was conducted in 600 northern Chinese villages (clusters). Patients who self-reported a hospital diagnosis of stroke were included in this prespecified subgroup analysis. Data were analyzed from November 2023 to August 2024. INTERVENTIONS: Participants were assigned to use either a salt substitute, consisting of 75% sodium chloride and 25% potassium chloride by mass, or regular salt. MAIN OUTCOMES AND MEASURES: The primary outcome was recurrent stroke. RESULTS: After excluding 5746 persons without a baseline history of stroke, 15 249 patients with stroke (mean [SD] age, 64.1 [8.8] years; 6999 [45.9%] female; 8250 male [54.1%]) were included. Over a median (IQR) follow-up of 61.2 (60.9-61.6) months, the mean difference in systolic blood pressure was -2.05 mm Hg (95% CI, -3.03 to -1.08 mm Hg). A total of 2735 recurrent stroke events (691 fatal and 2044 nonfatal) and 3242 deaths were recorded. Recurrent stroke was significantly lower in the salt substitute vs regular salt group (rate ratio [RR], 0.86; 95% CI, 0.77-0.95; P = .005), with larger effects on hemorrhagic stroke (relative reduction, 30%; P = .002). Death rates were also significantly lower (RR, 0.88; 95% CI, 0.82-0.96; P = .003), with larger effects on stroke-related deaths (relative reduction 21%; P = .01). No significant difference was observed for hyperkalemia (RR, 1.01; 95% CI, 0.74-1.38; P = .96). CONCLUSIONS AND RELEVANCE: Results of this cluster trial demonstrate that salt substitution was safe, along with reduced risks of stroke recurrence and death, which underscores large health gains from scaling up this low-cost intervention among patients with stroke. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02092090.

INTRODUCTION: Providing tools for comprehensively evaluating scintigraphy images could enhance transthyretin amyloid cardiomyopathy (ATTR-CM) diagnosis. This study aims to automatically detect and score ATTR-CM in total body scintigraphy images using deep learning on multi-tracer, multi-scanner, and multi-center datasets. METHODS: In the current study, we employed six datasets (from 12 cameras) for various tasks and purposes. Dataset #1 (93 patients, RESULTS: In the internal test set, all models for detection and scoring achieved an AUC of more than 0.95 and an F1 score of more than 0.90. For detection in the external dataset, AUCs of 0.93, 0.95, and 1 were achieved for datasets 3, 4, and 5, respectively. For the scoring task, AUCs of 0.95, 0.83, and 0.96 were achieved for these datasets, respectively. In dataset #6, we found ten cases flagged as ATTR-CM by the network. Out of these, four cases were confirmed by a nuclear medicine specialist as possibly having ATTR-CM. GradCam and saliency maps showed that the deep-learning models focused on clinically relevant cardiac areas. CONCLUSION: In the current study, we developed and evaluated a fully automated pipeline to detect and score ATTR-CM using large multi-tracer, multi-scanner, and multi-center datasets, achieving high performance on total body images. This fully automated pipeline could lead to more timely and accurate diagnoses, ultimately improving patient outcomes.