Timely PCI Shows Beneficial Long-Term Outcomes in Late Presentation With STEMI: A Systematic Review and Meta-Analysis Between 2012 and 2022

Introduction: Approximately 8-40% of ST-elevation Myocardial Infarction (STEMI) present later than 12 hours after symptom onset. Current ACC/AHA guidelines recommend primary percutaneous coronary intervention (PCI) for STEMI after 12 hours of symptom onset only in the setting of cardiogenic shock or severe acute heart failure, (Class Ia, LOE B) or persistent ischemic symptoms (Class IIa, LOE B). There are limited data comparing long-term outcomes among patients with a late STEMI presentation managed with PCI versus medical therapy (MT). Objective(s): To compare long-term outcomes among patients treated with PCI versus MT who have late presentation of STEMI Methods: We followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to extract data from PubMed/Medline, Cochrane, Embase, and Clinicaltrials.gov databases by using the search terms "late" or "delayed" or ">12 hours" presentation with STEMI from 01/2012 through 12/2022. Included studies reported at least one of the following outcomes: all-cause mortality, reinfarction, heart failure, major adverse cardiac events (MACE), and stroke. Studies reporting delays in PCI due to COVID-19 positive status or COVID-19 enforced protocols were excluded to prevent the impact of pragmatic barriers on treatment. Relative risk (RR) was calculated using random effects model if heterogeneity was >50%, otherwise, fixed effects model was used Results: Seven studies (n=11,576, delayed PCI n=6,248, and medical therapy n=5,319) were included in our analysis. The median follow-up was 12 months (1-60 months). Overall, among patients with STEMI and PCI >12 hour after presentation had lower incidence of MACE (27% vs. 30%, RR 0.85, 95% CI 0.76-0.69, I2=30%, p=0.007) compared to MT alone, which was driven by a significantly reduced all-cause mortality with PCI (4.4% vs. 17%, RR 0.38, 95% CI 0.17-0.85, I2=95%, p=0.01). No significant differences were observed in the incidence of recurrent MI and heart failure hospitalizations. Conclusion(s): Our study suggests favorable outcomes of PCI in STEMI with presentation >12 hours compared with medical therapy. Further prospective studies are needed to validate our findings.

"We need to keep making stuff, regardless of what the situation is": creativity and the film festival sector during COVID-19

Purpose In-person film festival experiences have faced uncertain futures since the spread of COVID-19. Snap-lockdowns, unclear and rapidly changing rules to public density allowances in theatres, distribution and challenges of "working-from-home" have become prominent issues to creative and cultural workers employed within the film festival ecosystem. The purpose of this paper, drawing from a series of interviews with film festival directors, organisers and workers within Australia, offers insight into the working lives of those employed within the film festival sector during 2020. Design/methodology/approach Using the research team's existing professional networks and a targeted approach of participant recruitment, this paper draws upon interview data from 5 semi-structured interviews with participants located in various Australian capital cities, who were working in the film festival sector during 2020. Participants were all mid-career, having at least 5 years of employment experience within the film festival ecosystem (directors, programmers and content creators) as well as having experience in other adjacent cultural and creative work. Findings The results in this study highlight common concerns of the legacy precarity has on professional and creative practice for those engaged in creative and cultural work, but also of unusual and unexpected opportunities for creativity and new film festival delivery beyond the dominant mode of in-theatre only experience pre-COVID-19. Originality/value The originality of this study lies in its qualitative exploration of the various employment experiences of Australian film festival workers during COVID-19.

Fire, pestilence and the extractive economy: cultural policy after cultural policy

Australia has witnessed long-standing cuts in the arts and culture federal budget. Most recently, the disappearance of the arts portfolio into a “super-ministry” along with infrastructure, transport, regional development and communications further signals the lack of support, both ideologically through public rhetoric, and financially through (absent) support packages, the current federal government holds towards the arts and arts workers. This paper accounts for how such ideological fractures have underserved freelancers, casuals, temporary and part-time workers in the arts who missed out on the critical initial support packages, and how state governments were more willing to make up for this initial shortfall. This paper further accounts for how the federal government lacks the necessary understanding of working patterns of those engaged in creative occupations, and over emphasizes funding bailouts for primary industry. This also has broader implications for how women are disproportionately impacted by sectors the federal government chooses to support. © 2020 Informa UK Limited, trading as Taylor & Francis Group.