Circulation最新文献

{"title":"PUS7-Mediated Pseudouridylation of TGFBI Drives Vascular Remodeling in Pulmonary Hypertension.","authors":"Junting Zhang, Yiying Li, Muhua He, Jianxin Tan, Yuan Chen, Zhongyuan Lin, Hongbo Wang, Fang Liu, Xiaolin Chen, Zihui Jia, Hanbin Chen, Zhen Chen, Fanhao Kong, Jiawen Fu, Jin-Song Bian, Xiao-Wei Nie","doi":"10.1161/CIRCULATIONAHA.126.080714","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.126.080714","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary hypertension (PH) is a life-threatening cardiovascular disorder characterized by irreversible pulmonary vascular remodeling and poor prognosis. RNA pseudouridylation, the most evolutionarily conserved RNA epigenetic modification, and its catalytic enzyme pseudouridine synthase 7 (PUS7) remained uncharacterized in PH, representing a major gap in the understanding of the epigenetic pathogenesis of the disease.</p><p><strong>Methods: </strong>We generated the first single-base resolution pseudouridine (Ψ) landscape in lung tissues of patients with PH using bisulfite-induced deletion sequencing. PUS7 expression was analyzed in hypoxic pulmonary artery endothelial cells, the lung tissues of patients with PH, and SU5416-hypoxia rodent model. The functional roles of PUS7 were investigated through genetic manipulation (PUS7-deficiency cells, adeno-associated virus serotype-mediated overexpression, endothelial cell-specific knockdown, and heterozygous knockout mice) and pharmacological inhibition with NSC107512.</p><p><strong>Results: </strong>Bisulfite-induced deletion sequencing revealed global Ψ dysregulation in the lung tissues of patients with PH. Among PUS family members, PUS7 was the most markedly upregulated in these tissues and in the hypoxic pulmonary artery endothelial cells. Both gene knockdown and pharmacological inhibition with NSC107512 ameliorated PH, whereas adeno-associated virus serotype-mediated PUS7 overexpression exacerbated disease progression. RNA immunoprecipitation sequencing and mutagenesis studies demonstrated that PUS7 bound to and catalyzed Ψ at position 688 of TGFBI (transforming growth factor β-induced protein) mRNA, thereby stabilizing TGFBI and activating phosphatidylinositol 3-kinase-protein kinase B signaling pathway. Furthermore, hypoxia-inducible factor 2α bound directly to the PUS7 promoter, establishing a hypoxia-inducible factor 2α/PUS7/TGFBI/phosphatidylinositol 3-kinase-protein kinase B positive feedback loop that drives PH pathogenesis.</p><p><strong>Conclusions: </strong>PUS7-mediated pseudouridylation serves as a novel epigenetic driver of PH through the hypoxia-inducible factor 2α/PUS7/TGFBI/phosphatidylinositol 3-kinase-protein kinase B axis, positioning PUS7 as a promising therapeutic target for this devastating disease.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":""},"PeriodicalIF":41.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter by Petersen et al Regarding Article, \"Randomized Controlled Trial of Mechanical Thrombectomy With Anticoagulation Versus Anticoagulation Alone for Acute Intermediate-High Risk Pulmonary Embolism: Primary Outcomes From the STORM-PE Trial\".","authors":"Timothy R Petersen, Ross S Hanson, Stephen P Malkoski","doi":"10.1161/CIRCULATIONAHA.126.079540","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.126.079540","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"154 9","pages":"e339-e340"},"PeriodicalIF":41.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter by Wang and Wang Regarding Article, \"Randomized Controlled Trial of Mechanical Thrombectomy With Anticoagulation Versus Anticoagulation Alone for Acute Intermediate-High Risk Pulmonary Embolism: Primary Outcomes From the STORM-PE Trial\".","authors":"Congxiao Wang, Hujun Wang","doi":"10.1161/CIRCULATIONAHA.126.080015","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.126.080015","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"154 9","pages":"e341-e342"},"PeriodicalIF":41.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response by Lookstein and Rosovsky to Letters Regarding Article, \"Randomized Controlled Trial of Mechanical Thrombectomy With Anticoagulation Versus Anticoagulation Alone for Acute Intermediate-High Risk Pulmonary Embolism: Primary Outcomes From the STORM-PE Trial\".","authors":"Robert A Lookstein, Rachel P Rosovsky","doi":"10.1161/CIRCULATIONAHA.126.080967","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.126.080967","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":"154 9","pages":"e343-e344"},"PeriodicalIF":41.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Multitask Deep Learning Model for Pediatric Echocardiography Analysis.","authors":"Joseph Cho, Mrudang Mathur, Dhamanpreet Kaur, Matthew Duda, Adil Dahlan, Aravind Krishnan, Matthew Leipzig, Rohan Shad, Alexander K Gonzalez, Joseph Logan, Christa Seidman, Robyn Fong, Abhinav Kumar, Cyril Zakka, Elizabeth Carter, Asif Padiyath, Andrea Jones, Michael D Quartermain, Curtis P Langlotz, Matthew A Jolley, William Hiesinger","doi":"10.1161/CIRCULATIONAHA.126.080619","DOIUrl":"10.1161/CIRCULATIONAHA.126.080619","url":null,"abstract":"<p><strong>Background: </strong>Congenital heart defects afflict ≈1% of all births worldwide. Although deep learning has shown significant promise in automating and improving adult echocardiography analysis, existing pediatric-based models are often limited to single tasks and specific echocardiographic views. To address this, we introduce EchoAI-Peds, a multitask deep learning model for pediatric echocardiography. Our model was developed using the most comprehensive set of pediatric labels to date and is designed to integrate information from multiple views simultaneously.</p><p><strong>Methods: </strong>We trained a video-based vision transformer to simultaneously detect 28 congenital heart defects, structural and functional abnormalities, repairs, and interventions directly from complete pediatric echocardiography studies with multiple videos. Our model was developed using >700 000 videos derived from >12 000 studies performed at Stanford Medicine between 2014 and 2021. Specifically, our model was trained on 10 815 studies (median age, 8 [IQR 2-14] years; 45% female) and validated on 1294 studies (median age, 9 [IQR 2-15] years; 46% female). Model efficacy was tested on an internal held-out data set of 1336 studies from that same period. In addition, model generalizability was tested on a spatially and temporally distinct patient cohort at the Children's Hospital of Philadelphia using 2121 studies performed between 2024 and 2025.</p><p><strong>Results: </strong>Our model achieved macroaveraged area under the receiver operating characteristic curve (AUROC) values of 0.91 (95% CI, 0.90-0.92) on the internal test set (median age, 8 [IQR 2-14] years; 47% female) and AUROC values of 0.89 (95% CI, 0.88-0.90) on the external test set (median age, 6 [IQR 0.92-13] years; 44.4% female). Moreover, EchoAI-Peds significantly outperformed adult-based echocardiography foundation models trained on substantially larger data sets, including EchoCLIP (internal AUROC=0.58, 95% CI, 0.56-0.60; external AUROC=0.61, 95% CI, 0.59-0.62) and EchoPrime (internal AUROC=0.58, 95% CI, 0.57-0.61; external AUROC=0.60, 95% CI, 0.59-0.62). Finally, our model demonstrated robust performance across patient age, patient sex, and studies with varying numbers of videos.</p><p><strong>Conclusions: </strong>Our findings demonstrate the remarkable potential for multitask deep learning models to aid the interpretation of pediatric echocardiograms. In addition, our results underscore the need for models that are specifically tailored to pediatric populations.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":"789-800"},"PeriodicalIF":41.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13416711/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148599635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Important Residual Lesions and Early Unplanned Reinterventions After Pediatric Cardiac Surgery: A Scientific Statement From the American Heart Association.","authors":"John M Costello, Mjaye L Mazwi, Christine M Riley, Cesar E Gonzalez de Alba, Laura J Olivieri, Cynthia K Rigsby, Kevin D Hill, Emile Bacha, Jane W Newburger, Meena Nathan","doi":"10.1161/CIR.0000000000001465","DOIUrl":"https://doi.org/10.1161/CIR.0000000000001465","url":null,"abstract":"<p><p>Optimal outcomes for congenital heart surgery depend on the expertise and judgment of an integrated multidisciplinary clinical team. The best outcomes require a comprehensive understanding of the patient's anatomy and physiology, an appropriate therapeutic plan, a meticulously executed operation that is technically optimal and facilitated by lesion-specific anesthesia and perfusion strategies, and skilled perioperative care. A principal factor contributing to adverse outcomes is the presence of important residual lesions after surgery, which may necessitate early unplanned cardiac reinterventions during the index hospitalization. Such reinterventions occur in ≈5% of all pediatric cardiac operations, with a higher incidence in younger patients and more complex procedures. The presence of significant residual lesions and the need for unplanned reinterventions are strongly associated with increased morbidity, mortality, and resource use. Wide center-level variation in the incidence and timing of unplanned reinterventions suggests an opportunity for quality improvement. In this scientific statement, we summarize the incidence, risk factors, and clinical outcomes of important residual lesions and early unplanned cardiac reinterventions. We review postoperative monitoring strategies and clinical indicators suggestive of a residual lesion, and we provide an overview of the noninvasive imaging modalities used for their identification and quantification. The roles of diagnostic and interventional cardiac catheterization in the management of residual lesions are discussed, along with surgical considerations for early reoperation. We highlight the importance of communication with patients and families. Last, key areas for future investigations are identified.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":""},"PeriodicalIF":41.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caffeine and Cardiovascular Disease: A Scientific Statement From the American Heart Association.","authors":"Gregory M Marcus, Frank B Hu, Rob M van Dam, Marilyn C Cornelis, Thomas A Dewland, JungHee Kang, Susanna C Larsson, Robert L Page, Niyati Parekh","doi":"10.1161/CIR.0000000000001454","DOIUrl":"10.1161/CIR.0000000000001454","url":null,"abstract":"<p><p>Caffeine is one of the most commonly consumed drugs in the world. It is found in various naturally occurring substances and can be ingested in a synthetically derived pure form. The majority of human subject-based research is observational and has focused on beverages and foods that contain caffeine. The relationships between caffeine and cardiovascular risk factors and diseases are complex, exhibiting heterogeneity depending on the nature of the caffeine consumed and individual-level propensities. Acute versus chronic caffeine-associated cardiovascular effects are often different. Most studies suggest an inverse J-shaped relationship between consumption of naturally occurring caffeinated products and blood pressure. Data on relationships between caffeine and diabetes are not consistent, but habitual coffee consumption has been associated with a lower risk of incident type 2 diabetes. Whereas no clear relationship between caffeine and blood lipids is evident, unfiltered coffee raises low-density lipoprotein cholesterol. Caffeine, studied primarily in the context of coffee, has been shown either to have no relationship or to be associated with a lower risk of coronary artery disease and heart failure. Randomized controlled trial data among regular caffeinated coffee drinkers showed that caffeinated coffee decreases the risk of atrial fibrillation occurrence but increases the frequency of premature ventricular contractions. Data are fairly consistent that moderate caffeine consumption, again studied primarily in the setting of coffee consumption, was associated with a lower risk of stroke. Data on high doses of caffeine such as that found in energy drinks are limited and generally suggest cardiovascular harm.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":"e345-e355"},"PeriodicalIF":41.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Noninvasive Thrombus Imaging in Patients With Ischemic Stroke.","authors":"Beth Whittington, Craig Balmforth, Alessandro Giaj Levra, Laura Clark, Neil Craig, Audrey White, Krithika Loganath, Evangelos Tzolos, Allison Winarski, Rachael O Forsythe, Michael McDermott, Tariq Ramtoola, Phyo H Khaing, Sphamandla Ntshangase, Mark G Macaskill, Stefan Veizades, Mairi Brittan, Tim Clark, Michelle Rooney, Christophe Lucatelli, Piotr J Slomka, Norman Koglin, Andrew W Stephens, Iris Hardewig, Edwin J R van Beek, Marc R Dweck, Joanna Wardlaw, Michelle C Williams, William N Whiteley, David E Newby","doi":"10.1161/CIRCULATIONAHA.126.080420","DOIUrl":"10.1161/CIRCULATIONAHA.126.080420","url":null,"abstract":"<p><strong>Background: </strong>Determining the source of thromboembolism in patients with acute ischemic stroke remains challenging because current diagnostic approaches rely largely on circumstantial and inferential associations rather than direct identification of the cause of stroke. Fluorine-18 GP1 ([¹⁸F]GP1) is a novel radiotracer that binds with high affinity and specificity to activated glycoprotein IIb/IIIa receptors on activated platelets. We aimed to determine whether hybrid [¹⁸F]GP1 positron emission tomography (PET) and computed tomography angiography could identify in vivo cardiovascular thromboembolism in patients with acute ischemic stroke and provide a mechanism-based assessment of stroke etiology.</p><p><strong>Methods: </strong>In a single-center prospective observational cohort study, 100 patients presenting with acute ischemic stroke underwent hybrid [¹⁸F]GP1 PET/computed tomography angiography within 21 days of symptom onset in addition to standard-of-care stroke investigations. Stroke etiology was classified using the causative classification system by an expert stroke physician blinded to [¹⁸F]GP1 PET findings. In parallel, [¹⁸F]GP1 PET/computed tomography angiography images were analyzed independently by readers who were blinded to all clinical data and causative classification system classification. We assessed whether [¹⁸F]GP1 PET/computed tomography angiography could identify the source of in vivo cardiovascular thromboembolism, influence stroke classification, and predict recurrent cerebrovascular events.</p><p><strong>Results: </strong>Cardiovascular [¹⁸F]GP1 uptake indicative of thrombosis was identified in nearly two-thirds (n=63) of participants, changing stroke classification in over a quarter (n=26) of patients. In those with stroke of undetermined cause, the source of thrombus was identified in 18 of 41 (44%) participants, which included nonstenotic carotid atherothrombosis, native cardiac valve thrombosis, and paradoxical thromboembolism. During a median follow-up of 613 (interquartile interval, 251-788) days, recurrent stroke or transient ischemic attack occurred in 14 patients, 13 (93%) of whom had cardiovascular [¹⁸F]GP1 uptake at baseline. Cardiovascular [¹⁸F]GP1 uptake was associated with a 10.4-fold increased risk of recurrent events (95% CI, 1.35-79.40; <i>P</i>=0.024).</p><p><strong>Conclusions: </strong>Noninvasive thrombosis imaging is a novel technique that enables direct in vivo identification of thrombus formation and frequently reveals the source of thromboembolism in patients with acute ischemic stroke. This approach represents a shift from inference-based to mechanism-based stroke classification with potential implications for targeted prevention strategies and better patient outcomes.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique Identifier: NCT05636748.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":""},"PeriodicalIF":41.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathology of Genetic Variants in Spontaneous Coronary Artery Dissection.","authors":"Takamasa Tanaka, Rika Kawakami, Brady J Gaynor, Desiree Williams, Jacques Augenstreich, Atsushi Sakamoto, Hiroyuki Jinnouchi, Kenji Kawai, Takao Konishi, Tatsuya Shiraki, Teruo Sekimoto, Takafumi Nakayama, Kazuhiro Fujiyoshi, Tomoyo Hamana, Yusuke Adachi, Keisha Medina Diaz, Charles C Hong, Alyssa Grogan, Braxton D Mitchell, Renu Virmani, Aloke V Finn","doi":"10.1161/CIRCULATIONAHA.126.080495","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.126.080495","url":null,"abstract":"<p><strong>Background: </strong>Spontaneous coronary artery dissection (SCAD) is characterized by a separation of the coronary artery wall, causing myocardial infarction and sudden death. This study is one of the first to clarify the impact of pathological genetic variants in candidate SCAD-related genes on the histopathological and morphological properties of human SCAD lesions.</p><p><strong>Methods: </strong>A total of 28 SCAD cases were selected from the CVPath Autopsy Registry. Histological differences in collagen and smooth muscle cells were compared among 3 groups: culprit SCAD (C-SCAD), defined as the coronary segment containing a dissection in cases with SCAD; nonculprit SCAD, defined as unaffected coronary segments (ie, healthy arteries) in cases with SCAD; and non-SCAD controls. Whole-exome sequencing was performed, and the identified variants were filtered to isolate pathogenic or likely pathogenic variants. Protein expression corresponding to the identified variants was assessed by immunostaining.</p><p><strong>Results: </strong>Collagen content was significantly reduced in C-SCAD lesions compared with controls, and immunohistochemical staining for smoothelin was reduced in the media of C-SCAD lesions compared with controls, whereas there were no significant differences between C-SCAD and nonculprit SCAD. Further, the nuclear height/width ratio of smooth muscle cells was increased, suggesting smooth muscle cell phenotypic modulation. In whole-exome sequencing analysis, pathogenic or likely pathogenic variants were detected in 25% of cases, which showed a higher frequency of multivessel dissection. In SCAD cases with pathogenic or likely pathogenic variants in <i>COL3A1</i> (collagen type III alpha 1), <i>FBN1</i> (fibrillin-1), or <i>FLNA</i> (filamin A), the expression of the corresponding protein was reduced in the media.</p><p><strong>Conclusions: </strong>Reduced medial collagen and smooth muscle cell phenotypic modulation may be possible predisposing conditions for SCAD, regardless of the presence of pathogenic or likely pathogenic variants. The presence of pathogenic variants in extracellular matrix-related genes may further compromise arterial wall medial integrity, contributing to more severe disease. These findings provide novel pathological and genetic insights into the pathogenesis of SCAD and may inform future diagnostic and therapeutic strategies.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":""},"PeriodicalIF":41.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation Between EMS Agency Rates of Survival to Hospital Admission and Hospital Survival Outcomes for Cardiac Arrest.","authors":"Tanawat Attachaipanich, Saket Girotra, Kevin F Kennedy, Bryan F McNally, Paul S Chan","doi":"10.1161/CIRCULATIONAHA.126.079735","DOIUrl":"10.1161/CIRCULATIONAHA.126.079735","url":null,"abstract":"<p><strong>Background: </strong>Survival to hospital admission for out-of-hospital cardiac arrest is an important resuscitation outcome to gauge emergency medical service (EMS) agency performance. However, its correlation with EMS rates of survival to hospital discharge and favorable neurological survival is unclear.</p><p><strong>Methods: </strong>Using the Cardiac Arrest Registry to Enhance Survival (CARES), we identified adults with nontraumatic out-of-hospital cardiac arrests during 2 periods: 2015 through 2019 (before the COVID-19 pandemic) and 2022 through 2024 (after the peak pandemic years). Multivariable hierarchical logistic regression was used to derive EMS agency-level risk-standardized survival rates for hospital admission, hospital discharge, and favorable neurological survival during each period. We then assessed the correlation between EMS agency rates of survival to admission versus discharge and favorable neurological survival using weighted linear regression, and whether the correlations differed by neighborhood income (above versus below median household income) and race and ethnicity (categorized as predominantly White [>80% of residents], majority Black or Hispanic [>50% of residents], or integrated).</p><p><strong>Results: </strong>A total of 544<b> </b>296 events from 1838 EMS agencies met inclusion criteria (252<b> </b>137 pre-COVID; 292<b> </b>159 post-COVID). During the period of 2015 to 2019, EMS rates of survival to admission were strongly correlated with survival to discharge (weighted <i>r</i>=0.68 [95% CI, 0.64-0.72]) and favorable neurological survival (weighted <i>r</i>=0.54 [95% CI, 0.43-0.59]). These correlations were similar during the period of 2022 through 2024 (weighted <i>r</i>=0.63 [95% CI, 0.59-0.66] and weighted <i>r</i>=0.48 [95% CI, 0.44-0.53], respectively). Neighborhood racial and ethnic composition modified the correlation between EMS rates of survival to admission and survival outcomes at discharge in both periods (all interactions <0.05), but the correlations remained strong in each neighborhood group. Similar findings were found for the interactions by neighborhood income strata.</p><p><strong>Conclusions: </strong>EMS agency rates of survival to hospital admission are strongly correlated with their rates of survival to hospital discharge and favorable neurological survival. These findings support the use of survival to hospital admission as a performance metric for EMS systems.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":""},"PeriodicalIF":41.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}