U–Pb zircon ages, geochemical and isotopic compositions of granitoids in Songpan-Garze fold belt, eastern Tibetan Plateau: constraints on petrogenesis and tectonic evolution of the basementevolution of the basement

The Songpan-Garze fold belt, located in the eastern part of the Tibetan Plateau, covers a huge triangular area bounded by the Yangtze (South China), the North China and the Tibetan Plateau blocks. In the northeastern part of the Songpan-Garze fold belt, the Yanggon and Maoergai granitoids provide insights into regional tectono-magmatic events, basement nature and tectonic evolution. U–Pb zircon SHRIMP dating shows that the Yanggon and Maoergai granitoids have magmatic crystallization ages of 221 ± 3.8 Ma and 216 ± 5.7 Ma, respectively. Both the granitoids display adakitic geochemical signatures, suggesting that their magma was derived from partial melting of thickened lower crust. Pb–Sr–Nd isotopic compositions for granitoids reveal that there is an unexposed Proterozoic basement in the Songpan-Garze belt, which has an affinity with the Yangtze block. During development of the Paleo-Tethys ocean, the basement of the Songpan-Garze belt would be a peninsula approaching the Paleo-Tethys ocean from the Yangtze block

Clinical Outcomes According to ECG Presentations in Infarct-Related Cardiogenic Shock in the Culprit Lesion Only PCI vs Multivessel PCI in Cardiogenic Shock Trial

Background: The impact of ECG presentations of acute myocardial infarction (AMI) in cardiogenic shock is unknown. Research Question: In myocardial infarction with cardiogenic shock, is there a difference in the outcomes and effect of revascularization strategies between non-ST-segment elevation myocardial infarction (NSTEMI) and left bundle branch block myocardial infarction (LBBBMI) vs ST-segment elevation myocardial infarction (STEMI)? Study Design and Methods: Cardiogenic shock patients from the CULPRIT-SHOCK trial with NSTEMI or LBBBMI were compared with STEMI patients for 30-day and 1-year all-cause mortality. The interaction between ECG presentation and the effect of revascularization strategies on outcomes was evaluated. Results: Of 665 cardiogenic shock patients analyzed, 55.9% demonstrated STEMI, 29.3% demonstrated NSTEMI, and 14.7% demonstrated LBBBMI. Patients differed in mean age (68.0 years in STEMI patients, 71.0 years in NSTEMI patients, and 73.5 years in LBBBMI patients; P =.015), cardiovascular risk factors, and angiographic severity. No difference was found in the 30-day risk of death between NSTEMI and STEMI patients (48.7% vs 43.0%; adjusted OR [aOR], 1.05; 95% CI, 0.66-1.67; P =.85), nor between LBBBMI and STEMI patients (59.2% vs 43.0%; aOR, 1.31; 95% CI, 0.73-2.34; P =.36). Although the univariate risk of death by 1 year was higher in NSTEMI and LBBBMI patients compared with STEMI patients, ECG presentation was not an independent risk factor of mortality after adjustment (NSTEMI vs STEMI: 56.4% vs 46.8%; aOR, 1.21; 95% CI, 0.76-1.92; P =.42; LBBBMI vs STEMI: 69.4% vs 46.8%; aOR, 1.59; 95% CI, 0.89-2.84; P =.12). ECG presentation did not modify the effect of the revascularization strategy on 30-day and 1-year mortality (P =.91 and P =.97 for interaction). Interpretation: In patients with cardiogenic shock, NSTEMI and LBBBMI presentations reflect higher-risk profiles than STEMI presentations, but are not independent risk factors of mortality. ECG presentations did not modify the treatment effect, supporting culprit-lesion-only percutaneous coronary intervention as the preferred strategy across the AMI spectrum