Valentin al Jalali

In patients presenting with acute coronary syndrome (ACS) and multivessel disease, it is unclear whether non-culprit lesions should be revascularized immediately or in a staged procedure. We performed a meta-analysis of randomized controlled trials that compared immediate versus staged revascularization strategies. Two authors independently screened records from the online databases PubMed, Embase, Web of Science, and the Cochrane Library to identify eligible trials up to November 2025. The primary outcome was all-cause mortality at 1 year. Secondary outcomes included cardiovascular events at 1 year. Meta-regressions were performed to explore the influence of study-level characteristics. This study was registered in PROSPERO (CRD42023446181). Ten trials with a total of 5651 patients were included in the final analysis. All-cause death at 1 year occurred in 109 (3.9%) of 2809 patients in the immediate revascularization group and 100 (3.5%) of 2842 patients in the staged revascularization group (risk ratio, 1.10; 95% CI 0.79–1.52). Cardiovascular death at 1 year occurred in 76 (2.8%) of 2749 patients in the immediate revascularization group and 66 (2.4%) of 2768 patients in the staged revascularization group. Meta-regression suggested that higher mean patient age was significantly associated with a lower risk ratio favoring the immediate revascularization group (regression coefficient -0.10; 95% CI -0.16 to -0.002; p = 0.047). All-cause mortality and cardiovascular deaths were similar in patients with ACS, predominantly with STEMI, and multivessel coronary disease undergoing immediate or staged revascularization. The available effect estimates do not exclude the possibility of clinically meaningful benefit or harm from immediate revascularization.

The current standard method for the analysis of potential drug–drug interactions (pDDIs) is time‐consuming and includes the use of multiple clinical decision support systems (CDSSs) and the interpretation by healthcare professionals. With the emergence of large language models developed with artificial intelligence, an interesting alternative arose. This retrospective study included 30 patients with polypharmacy, who underwent a pDDI analysis between October 2022 and August 2023, and compared the performance of Chat GPT and established CDSSs (MediQ®, Lexicomp®, Micromedex®) in the analysis of pDDIs. A multidisciplinary team interpreted the obtained results and decided upon clinical relevance and assigned severity grades using three categories: (i) contraindicated, (ii) severe, (iii) moderate. The expert review identified a total of 280 clinically relevant pDDIs (3 contraindications, 13 severe, 264 moderate) using established CDSSs, compared with 80 pDDIs (2 contraindications, 5 severe, 73 moderate) using Chat GPT. Chat GPT almost entirely neglected pDDIs with the risk to QTc prolongation (85 vs. 8), which could also not be sufficiently improved by using a specific prompt. To assess the consistency of the results provided by Chat GPT, we repeated each query and found inconsistent results in 90% of the cases. In contrast, Chat GPT provided acceptable and comprehensible recommendations for specific questions on side effects. The use of Chat GPT for the identification of pDDIs cannot be recommended currently, because clinically relevant pDDIs were not detected, there were obvious errors and results were inconsistent. However, if these limitations are addressed accordingly, it is a promising platform for the future.