Search Results (12,553)

Breast cancer remains one of the most prevalent malignancies affecting women worldwide and continues to be a leading cause of cancer-related morbidity and mortality. Patients may present with either localized or advanced disease, with clinical outcomes increasingly influenced by molecular subtype and genetic profile. This review highlights the key genetic factors involved in breast cancer, current diagnostic and therapeutic strategies, and promising emerging approaches that may shape future clinical management. Breast cancer diagnosis typically involves clinical breast examination, imaging techniques such as mammography and ultrasound, and confirmatory biopsies. Genetic mutations in specific genes are strongly linked to the development, progression, and metastasis of the disease. Treatment options for localized breast cancer continue to include surgery (lumpectomy or mastectomy) and radiotherapy, combined with systemic therapies tailored to tumor biology, such as endocrine therapy, human epidermal growth factor receptor 2 (HER2)-targeted therapy, and cyclin-dependent kinase (CDK)4/6 inhibitors. For advanced or metastatic breast cancer, recent therapeutic advances include the use of immunotherapy (e.g., immune checkpoint inhibitors), Poly (ADP-ribose) polymerase (PARP) inhibitors for Breast Cancer gene (BRCA)-mutated cancers, antibody–drug conjugates, and novel targeted agents, which have significantly improved patient outcomes in selected populations. Recent findings in breast cancer genetics have highlighted the critical role of germline and somatic mutations, particularly in genes such as BRCA1, BRCA2, phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA), and TP53, in driving tumor initiation, progression, and therapeutic response. Molecular profiling and next-generation sequencing technologies have enabled more precise tumor classification and facilitated the development of personalized treatment strategies. Despite these advances, treatment resistance and disease recurrence remain major challenges, particularly in aggressive subtypes such as triple-negative breast cancer. Consequently, ongoing research is exploring alternative and complementary approaches, including nanotechnology-based drug delivery systems, gene editing techniques such as clustered regularly interspaced short palindromic repeats-Cas9 (CRISPR-associated protein 9) (CRISPR-Cas9), cancer vaccines, and the integration of traditional and plant-derived compounds. These strategies aim to enhance therapeutic efficacy, reduce systemic toxicity, and overcome resistance mechanisms. Full article

Background: Influenza-associated encephalopathy, encephalitis, and acute necrotizing encephalopathy (ANE) are rare but potentially life-threatening neurological complications of influenza. Adult cases remain poorly characterized because the available literature is largely limited to isolated case reports and small case series. Methods: A PRISMA-guided scoping review of the MEDLINE database was conducted through 31 May 2026. Published adult cases of influenza-associated encephalopathy, encephalitis, and ANE were identified and analyzed for demographic characteristics, clinical presentation, neuroimaging findings, treatment, and outcomes. Results: Eighty-three adult cases reported between 1958 and 2026 were included. The mean age was 45.6 ± 17.8 years, and 57.8% were male. Two-thirds did not have any underlying comorbidities. Neurological symptoms developed a mean of 4.6 days after influenza onset, with influenza A accounting for 80.7% of infections. Fever (91.6%), altered mental status (86.7%), and seizures (36.1%) were the most common manifestations. Encephalitis was the predominant presentation (44.5%), followed by encephalopathy (31.3%) and ANE (24.1%). MRI most frequently demonstrated cerebral hemispheric lesions (53.0%) and bilateral thalamic involvement (36.4%), while EEG abnormalities were reported in 69.6% of patients. Overall mortality was 22.9%, highest among patients with ANE (45.0%). Among survivors, 28.9% experienced persistent neurological sequelae. Conclusions: Influenza-associated encephalopathy, encephalitis, and ANE are rare in adults but are associated with substantial morbidity and mortality. This review represents the largest adult cohort reported to date and provides important insights into the clinical spectrum, neurodiagnostic findings, and outcomes of these uncommon complications. This review highlights significant gaps in knowledge and the need for collaborative multicenter studies to improve the diagnosis, treatment, and outcome of these severe complications of influenza infection. Full article

Background: Lung infections represent a major cause of morbidity and mortality in patients with cystic fibrosis (CF) and are predominantly associated with chronic infection by Pseudomonas aeruginosa. The clinical management of CF lung disease is increasingly compromised by the emergence of multidrug-resistant strains, biofilm formation, and the expression of multiple virulence determinants. Antimicrobial peptides (AMPs), evolutionarily conserved effectors of innate immunity, have emerged as promising therapeutic candidates due to their ability to exert both bactericidal and anti-virulence activities. In this study, we investigated the antimicrobial and mechanistic effects of Ranalexin-1G, an AMP derived from the skin secretion of Rana grylio, against P. aeruginosa, for which its antibacterial activity has not previously been reported in the literature. Methods: Antibacterial activity was determined against the reference strain and three clinical isolates of P. aeruginosa by broth microdilution assays, time-kill kinetics and anti-biofilm assays, while peptide-mediated modulation of virulence was evaluated through transcriptional analysis of key virulence-associated genes by RT-PCR. The impact of Ranalexin-1G on host–pathogen interactions was further assessed using bacterial invasion assays in human bronchial epithelial cells (BEAS-2B). Results: Ranalexin-1G exerted a rapid bactericidal effect within 6 h at non-cytotoxic concentrations and displayed modest anti-biofilm effects, with greater efficacy in inhibiting biofilm formation. Mechanistically, peptide treatment resulted in a reduction in the expression of selected genes involved in biofilm formation and virulence, including those associated with alginate biosynthesis and type III secretion system-mediated cytotoxicity. Consistently, Ranalexin-1G markedly impaired bacterial invasion of epithelial cells, indicating interference with early host–pathogen interaction processes. Notably, the peptide displayed robust antimicrobial activity against multidrug-resistant P. aeruginosa clinical isolates from CF patients. Conclusions: Collectively, these findings suggest that Ranalexin-1G acts through a dual mechanism involving direct bactericidal activity and modulation of selected virulence pathways, supporting further investigation of its potential as an anti-virulence and host-directed approach for the treatment of chronic P. aeruginosa infections in cystic fibrosis. Full article

Background and Objectives: The Ankura stent graft was introduced in Europe in 2015 for the endovascular repair of infrarenal abdominal aortic aneurysms (AAAs). Evidence regarding its long-term efficacy remains limited. This study presents eight years of clinical experience with the Ankura endograft for endovascular aneurysm repair (EVAR) at a tertiary university vascular center. Materials and Methods: This single-center retrospective study included patients who underwent elective EVAR with the Ankura endograft between January 2015 and January 2023. All patients were anatomically suitable according to the instructions for use (IFU). Computed tomography angiography was performed at 1 and 12 months and annually thereafter during follow-up; the surveillance protocol was subsequently modified to use duplex ultrasound. Primary outcomes were categorized as early (technical success, clinical success, and 30-day mortality and morbidity) or late (aneurysm-related and non-aneurysm-related mortality). Results: A total of 220 patients were included (211 men [95.9%]); the mean age was 71.41 years (range, 49–87 years); and the mean aneurysm diameter was 59.15 mm (range, 32–109 mm). Primary and secondary technical success rates were 97.3% and 100%, respectively, and the clinical success rate was 96.8%. Thirty-day morbidity and mortality rates were 6.3% and 0%, respectively. No perioperative conversions occurred. The mean follow-up duration was 51.76 months (range, 1–131 months). Freedom from reintervention at 24, 36, 48, and 72 months was 98.2%, 97.7%, 97.2%, and 95.9%, respectively. Iliac limb patency was 99.5%. Aneurysm-related and non-aneurysm-related mortality during follow-up were 2.2% and 20.45%, respectively. Conclusions: In this study, the Ankura AAA stent graft demonstrated durable efficacy, with a high iliac limb patency rate, a low reintervention rate, and low aneurysm-related mortality during follow-up. Its long-term efficacy and safety should be evaluated in larger studies. Full article

Background/Objectives: Respiratory infections are a major cause of morbidity and mortality among older adults. However, vaccination coverage against respiratory pathogens remains suboptimal, particularly in rural and vulnerable populations. This study aimed to identify factors associated with respiratory vaccination uptake among older adults living in rural Amazonian communities in Peru. Methods: We conducted an observational, analytical, cross-sectional study using secondary data from the Amazon Frail Project. A total of 429 adults aged ≥60 years from rural and suburban communities in San Martín, Loreto, and Ucayali were included. Vaccination coverage for influenza, pneumococcal disease, pertussis, and COVID-19, as well as vaccine combinations, was assessed. Multiple linear and Poisson regression models with robust variance were used to identify associated factors. Results: Complete vaccination coverage was 42.89% for influenza, 23.08% for pneumococcal disease, 4.43% for pertussis, and 70.16% for COVID-19. Only 3.50% of participants had received all four respiratory vaccines. Higher educational attainment, multimorbidity, social frailty, greater muscle mass, better physical performance, and healthcare center attendance were associated with higher vaccination uptake. Depressive symptoms, cognitive impairment, functional dependency, physical frailty, dynapenia, and higher body mass index were associated with lower vaccination uptake. Conclusions: Respiratory vaccination coverage was suboptimal among older adults living in rural Amazonian communities. Educational, functional, physical, social, and healthcare access factors significantly influenced vaccine uptake, highlighting the need for targeted immunization strategies in vulnerable rural populations. Full article

Community-acquired pneumonia is one of the main causes of morbidity and mortality due to infections worldwide. This has led to the study of the use of corticosteroids as adjunctive therapy, which has shown an inclination to provide clinical benefits. However, controversy persists regarding the use of one corticosteroid over another Objectives: Evaluate the outcomes associated with the use of hydrocortisone versus methylprednisolone in patients with community-acquired pneumonia. Methods: We conducted a multicenter retrospective cohort study that included hospitalized adults diagnosed with CAP at two high-complexity clinics in Colombia between 2010 and 2020. Propensity score matching was used in a 1:1 ratio to balance the baseline characteristics between the hydrocortisone and methylprednisolone groups. The primary outcome was 30-day mortality. Secondary outcomes included septic shock, vasopressor use, admission to the intensive care unit, mechanical ventilation, and other hospital outcomes. Survival analyses were performed using Kaplan–Meier curves and estimates of the average treatment effect, as well as subgroup analyses according to the dose and duration of treatment. Results: The study initially included 366 patients, with significant baseline differences between groups. After matching, an adjusted cohort of 168 patients (84 per group) was obtained, with an adequate balance of clinical, paraclinical, and severity-related variables. No statistically significant differences were found in 30-day mortality between patients who received hydrocortisone and those who received methylprednisolone before or after matching. Additionally, no differences were detected in the secondary clinical outcomes. Survival analyses revealed no differences according to corticosteroid type, treatment duration, or administered dose. Conclusions: In this retrospective propensity-score-matched cohort study, no differences were observed in 30-day mortality or other clinical outcomes between hydrocortisone and methylprednisolone in patients with community-acquired pneumonia. Full article

Congenital heart disease is the most common birth defect worldwide. Perinatal detection, either in utero or prior to hospital discharge is important for planning delivery, ordering adjunct testing, and planning for surgical or medical care. In countries with access to ultrasound screening, prenatal detection is highly accurate though with variable sensitivity and specificity around the world. Pulse oximetry screening, in some cases coupled with murmur auscultation in the nursery can also reach very high degrees of sensitivity for critical congenital heart disease. Use of the modalities per guidelines and recommendations is an important aspect of decreasing infant mortality and morbidity worldwide. Full article

Background: Pulmonary metastasectomy (PM) is an established component of multimodal oncological treatment, but its perioperative safety and long-term outcomes in patients with chronic obstructive pulmonary disease (COPD) remain insufficiently defined. We aimed to evaluate the impact of COPD on perioperative morbidity, mortality and long-term survival after PM. Methods: We retrospectively analysed 692 patients who underwent PM with curative intent. COPD severity was graded using the GOLD spirometric classification. Patients were classified according to their postbronchodilator FEV1/FVC ratio into a COPD group (<0.70) and a control group (≥0.70). Groups were compared regarding clinical and surgical characteristics, postoperative morbidity and mortality, and overall survival (Kaplan–Meier, log-rank). Independent predictors of morbidity and survival were identified via logistic and Cox regression, and a 1:1 propensity-score-matched analysis was performed to account for baseline imbalances. Results: Among 9684 patients, 692 (7.1%) patients underwent PM, of whom 171 (24.7%) had COPD. They were more frequently smokers and had a higher comorbidity burden and worse performance status and, as expected, significantly lower lung function. The main clinically relevant finding was a significantly higher rate of persistent air leak in patients with COPD (8.8% vs. 2.3%, p < 0.001). Overall morbidity and 30-day mortality, however, did not differ. With a median follow-up of 76.7 months, survival was similar between groups (3-year survival 76.5% vs. 78.4%, p = 0.495) and was unaffected by GOLD severity. Independent predictors of worse survival were preoperative systemic therapy (HR 2.18), repeat metastasectomy (HR 1.60) and increasing age (HR 1.02 per year). After propensity matching, survival remained comparable (HR 1.05, p = 0.835). Conclusions: Among carefully selected patients, COPD was not associated with increased mortality or reduced survival after PM, although persistent air leak was significantly more frequent. COPD alone should not, by itself, be considered a contraindication to curative-intent surgery in appropriately selected patients, and these findings should not be generalized to patients with severe or end-stage COPD. Full article

Background/Objectives: Thrombotic microangiopathies are rare, life-threatening hematological disorders characterized by microangiopathic hemolytic anemia, thrombocytopenia, and end-organ injury. This study was conducted in a setting where ADAMTS13 activity testing became available only from 2015 onward and complement-targeted therapy (eculizumab) had limited accessibility throughout most of the study period, conditions that shaped both diagnostic classification and treatment outcomes. Their clinical presentation, treatment response, and prognosis vary according to etiology, making early recognition and subtype classification clinically important. This study aimed to evaluate the etiological distribution, clinical features, treatment responses, and outcomes of adult patients with thrombotic microangiopathy at a tertiary-center real-world cohort. Methods: This retrospective cohort study included 47 adult patients (≥18 years) hospitalized with thrombocytopenia and microangiopathic hemolytic anemia (MAHA) in a nine-year period. Patients were classified as thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS), or secondary TMA based on clinical and laboratory evaluation. Demographic characteristics, clinical manifestations, laboratory parameters, treatments, and outcomes were analyzed. Results: The mean age was 45.3 ± 15.2 years, and 72.3% of patients were female. Primary thrombotic microangiopathy accounted for 74.5% of cases, including thrombotic thrombocytopenic purpura in 53.2% and hemolytic uremic syndrome in 21.2%; secondary thrombotic microangiopathy accounted for 25.5%. Hemodialysis was required in all patients with hemolytic uremic syndrome compared with 16% of those with thrombotic thrombocytopenic purpura. The complete response rate was 74.5%, and in-hospital mortality was 25.5%. In multivariable Cox regression analysis, treatment non-response and reduced post-treatment estimated glomerular filtration rate independently predicted mortality. Conclusions: Adult TMAs are characterized by considerable etiological and clinical heterogeneity, which makes differential diagnosis challenging, particularly in settings where access to contemporary diagnostic tests and targeted treatments is limited. In this cohort, in the absence of ADAMTS13 testing, TTP was the most frequent subtype, while treatment non-response and renal impairment emerged as the main factors associated with mortality. These findings emphasize the need for early clinical recognition and careful subtype-based differential diagnosis, which will reduce morbidity and mortality by permitting rapid initiation of pathophysiology-based appropriate interventions, i.e., PEx, immune suppression and caplacizumab for immune TTP and anti-complement therapy for aHUS, and limiting the inappropriate use of PEx with its complications, including sepsis. Full article

Immunocompromised patients face increased morbidity and mortality from central nervous system (CNS) opportunistic viral infections, with risk level driven by specific immune defects. While our diagnostic capacity expands, immunocompromised patients may present atypically or with mild symptoms, delaying or complicating diagnosis. Treatment options are often limited, although novel agents show promise. This review discusses why immunocompromised patients carry higher immunologic risk and how certain viral classes display neurotropism to invade the CNS. We outline the utility and limitations of current and emerging diagnostic strategies. We discuss specific opportunistic viral pathogens, denoting specific epidemiology or pathogenesis, clinical presentation, diagnostic findings, and treatment and prevention methods. While there still remain knowledge and treatment gaps, advancements in diagnostics and understanding of pathogens have begun to improve outcomes. Full article

Background/Objectives: Since the establishment of the Korean Neonatal Network (KNN) in 2013, numerous studies have been conducted using its nationwide registry of very low birth weight infants (VLBWIs). Beyond serving as a clinical database, the KNN has evolved into a national healthcare research infrastructure supporting multicenter collaboration, evidence generation, and quality improvement in neonatal care. This study aimed to evaluate the scientific productivity, collaborative structure, and knowledge-generation capacity of the KNN through bibliometric network analysis and to identify future research directions in Korean neonatal research. Methods: Publications from 1 January 2015 to 5 June 2024 were retrieved from the Web of Science Core Collection. Literature searches were performed using Medical Subject Headings (MeSH), Emtree terms, and related keywords associated with very low birth weight infants, extremely low birth weight infants, and the Korean Neonatal Network. A total of 7060 global publications and 86 KNN-related publications were identified for analysis. Co-authorship and keyword co-occurrence analyses were conducted using VOSviewer to evaluate international collaborations, research themes, and temporal trends in keyword emergence. Scimago Graphica was used to visualize keyword evolution, and burst detection analysis was performed using CiteSpace to identify emerging research topics. Results: Among global publications on VLBWIs, South Korea ranked 13th worldwide with 226 publications and demonstrated substantial international collaboration, particularly with researchers in the United States. Analysis of the 86 KNN-related publications revealed the rapid development of observational and topic-focused research areas within a relatively short period. Keyword clustering and temporal analyses demonstrated a progressive expansion of research interests as the database matured. Burst analysis identified emerging themes related to mortality and morbidity risk factors, neurodevelopmental outcomes, and predictive modeling using machine learning techniques. Conclusions: Bibliometric analysis demonstrated that research based on the KNN has largely followed global trends in neonatal research despite its relatively recent establishment. The KNN has successfully functioned as a nationwide research infrastructure facilitating collaborative knowledge generation and scientific productivity. Nevertheless, several underrepresented research areas and opportunities for broader international collaboration were identified. These findings may help guide future research strategies and maximize the impact of national neonatal registry-based healthcare systems. Full article

Background: Tuberculosis (TB) remains a leading cause of global morbidity and mortality, yet its impact extends far beyond microbiological cure. Many TB survivors experience persistent structural lung damage or functional impairment consistent with post-TB lung disease, while growing evidence highlights long-term non-respiratory health outcomes. Synthesizing evidence across lung and non- respiratory health outcomes, along with their risk factors, is critical to inform long-term TB care. Methods: We conducted a scoping review including systematic reviews reporting on post-TB long-term health outcomes. A search was performed in PubMed/MEDLINE on 27 July 2025, using terms related to “tuberculosis,” “systematic review,” “meta-analysis,” “sequelae” and “long-term health outcomes,” without language restrictions. Results: Nine systematic reviews met inclusion criteria. Most focused on pulmonary outcomes and consistently demonstrated that TB is associated with chronic airflow obstruction, reduced lung function, and an increased long-term risk of lung cancer, although residual confounding from environmental, clinical, and socioeconomic factors cannot be excluded. While younger adults are more prone to developing COPD after TB in high TB burden settings, older individuals face a higher risk of broader post-TB lung sequelae. Evidence suggested that TB survivors are at increased risk of non-respiratory complications. HIV co-infection, low CD4 counts, older age, pre-existing hepatitis, prior TB treatment, and hypoalbuminemia were associated with post-TB liver injury, while baseline hearing impairment and HIV co-infection increased the likelihood of post-TB hearing loss. TB was also linked to elevated risk of several non-pulmonary cancers, including oesophageal, cervical, hematological, pancreatic, and gastric malignancies, with the highest risk within the first year after TB diagnosis and persisting, though attenuated, in subsequent years. Conclusion: TB should be viewed as a chronic condition with enduring lung and non-respiratory health outcomes. TB survivors face increased risks of COPD, lung cancer, and a range of non-respiratory health outcomes, including hepatic and auditory complications, particularly among high-risk groups, such as those living with HIV infection, along with baseline hearing and hepatic impairment. Public health programmes must extend care beyond microbiological cure to include integrated, post-TB long-term monitoring of lung, hepatic and hearing across all ages, including malignancy surveillance, after baseline assessments to identify high-risk TB survivors. Future research should also elucidate risk factors for post-TB malignancy, and clarify the relationship between neurological, renal, and musculoskeletal sequelae and TB to inform evidence-based TB survivorship care. Full article

Background: Sickle cell disease (SCD) is the most common inherited blood disorder globally, affecting approximately 300,000 newborns annually. Cardiac remodeling, resulting from chronic anemia, vascular obstruction, and endothelial dysfunction, substantially contributes to morbidity and mortality in patients with SCD. Therefore, characterizing these patterns is essential to clinical management and outcome improvement in pediatric patients. However, a comprehensive synthesis of cardiac remodeling patterns in pediatric and adolescent patients with SCD and their associations with genotype and clinical severity is lacking. Methods: We conducted a systematic review in accordance with the PRISMA 2020 guidelines and searched five databases for studies published from January 1978 to December 2024. Of 1131 retrieved studies, 37 met the inclusion criteria; of these, 31 focused exclusively on children (Group A), while six included both children and adults (Group B). We analyzed cardiac remodeling patterns, genotype-specific findings, associations with disease severity, and imaging modalities. The 37 studies included approximately 4253 patients from 12 countries, representing diverse populations and imaging techniques. Results: Left ventricular (LV) dilation was the most frequently reported finding, noted in 33 of 37 studies (89.2%; representing study-level reporting frequency, not patient-level prevalence), followed by diastolic dysfunction (reported in 18 of 37 studies; 48.6%); elevated TRV (≥2.5 m/s) as an echocardiographic screening marker for pulmonary hypertension (PH) risk was found in 14 of 37 studies (37.8%; TRV ≥ 2.5 m/s is a screening criterion, not confirmed hemodynamic PH); myocardial fibrosis was found in three studies (8.1%, exclusively from mixed-age cohorts); and QTc prolongation/arrhythmia was found in one study (2.7%). The HbSS genotype was associated with the most severe cardiac changes. Studies that did not stratify by genotype subtype (HbS/β⁰ vs. HbS/β⁺) may underestimate cardiac severity in mixed-genotype cohorts. Markers of disease severity, such as elevated lactate dehydrogenase (LDH) expression, frequent acute chest syndrome (ACS), and increased hospitalizations, were associated with more pronounced cardiac remodeling in individual studies, but the cross-study consistency of this association varied. Study designs and imaging modalities also varied, underscoring the need for standardized assessment protocols to enhance comparability and clinical translation. This review presents a narrative synthesis; individual study statistics are reported as originally published, without formal pooled estimates. Conclusions: Cardiac abnormalities in SCD were reported from early childhood, with more advanced phenotypes being more frequently described in older adolescents and mixed-age cohorts, suggesting possible age-related progression requiring prospective confirmation. Principal limitations include retrospective PROSPERO registration (CRD420261435382), the predominance of cross-sectional study designs, the inconsistent z-score normalization of cardiac dimensions, the incomplete reporting of treatment exposure, the disproportionate contribution of mixed-age cohorts to advanced imaging findings, and inter-study heterogeneity in echocardiographic protocols. Full article

Background/Objectives: Cancer screening is a key strategy for reducing cancer-related morbidity and mortality. This study assessed adherence to breast, cervical, and colorectal cancer screening among Spanish women and identified factors independently associated with participation. Methods: A cross-sectional study was conducted using data from the 2023 Spanish Health Survey. Women eligible for mammography (40–69 years), cervical cytology (25–65 years), and fecal occult blood testing (FOBT; 50–69 years) were included. Weighted prevalence estimates were calculated, and multivariable logistic regression models were fitted separately for each screening test. Results: A total of 7454 women aged 25–69 years were analyzed. Adherence was highest for mammography (71.1%), followed by cervical cytology (64.1%) and FOBT (36.8%). Only 24.4% of women eligible for all three programs were adherent to all screening tests simultaneously. Across all screening programs, adherence was consistently associated with being born in Spain, living with a partner, greater social support, healthcare utilization, private health insurance coverage, and physical activity. Strong social support was independently associated with participation in mammography (OR 1.72; 95% CI 1.35–2.20), cervical cytology (OR 1.58; 95% CI 1.29–1.94), and FOBT uptake. Participation in one screening program was strongly associated with participation in the others, particularly between mammography and cervical cytology (OR 4.37; 95% CI 3.84–4.98). Conclusions: Adherence to cancer screening among Spanish women remains suboptimal, particularly for colorectal cancer. Participation appears to reflect a broader preventive health behavior pattern, with social support emerging as one of the strongest and most consistent determinants across all three screening programs. Full article

Background: Cardiac arrest complicating acute coronary syndrome (ACS) is associated with high mortality and neurological morbidity despite advances in percutaneous coronary intervention (PCI) and post-resuscitation care. This study evaluated clinical outcomes in ACS patients presenting with cardiac arrest undergoing invasive coronary angiography, with particular focus on resuscitation status before catheterization and location of cardiac arrest. Methods: A retrospective analysis of 15,595 ACS patients undergoing coronary angiography between 2014 and 2025 identified two cohorts. The first cohort included 131 patients stratified according to mechanical cardiac activity upon arrival to the catheterization laboratory: previously resuscitated patients (RES, n = 109) and patients in refractory cardiac arrest requiring automatic resuscitation devices (ARD, n = 22). The second cohort included 159 patients grouped by arrest location: out-of-hospital (OHCA, n = 83), in-hospital (IHCA, n = 48), and catheterization laboratory cardiac arrest (CLCA, n = 28). The primary outcomes were in-hospital mortality and neurological status after resuscitation. Results: In-hospital mortality was significantly higher in the ARD group compared with the RES group (86.4% vs. 39.4%, p < 0.001). Survivors in the RES group more frequently achieved favorable neurological recovery (66.2%). Mean resuscitation duration and admission lactate levels were significantly greater in the ARD group (66.1 vs. 21.9 min, p < 0.001; 10.7 vs. 7.7 mmol/L, p = 0.006). According to arrest location, mortality was highest in the CLCA group (78.6%), followed by IHCA (60.4%) and OHCA (39.8%) (p < 0.001). Despite high mortality, all surviving CLCA patients had favorable neurological outcomes. Culprit coronary vessel distribution was not associated with mortality or neurological outcome. Conclusions: In ACS patients with cardiac arrest, ongoing refractory arrest during coronary angiography and cardiac arrest occurring in the catheterization laboratory were associated with markedly increased mortality. Successful resuscitation prior to catheterization was associated with significantly better survival and neurological recovery. Full article