RESUMEN
BACKGROUND: Urban agglomerates play a crucial role in reaching global climate objectives. Many cities have committed to reducing their greenhouse gas emissions, but current emission trends remain unverifiable. Atmospheric monitoring of greenhouse gases offers an independent and transparent strategy to measure urban emissions. However, careful design of the monitoring network is crucial to be able to monitor the most important sectors as well as adjust to rapidly changing urban landscapes. RESULTS: Our study of Paris and Munich demonstrates how climate action plans, carbon emission inventories, and urban development plans can help design optimal atmospheric monitoring networks. We show that these two European cities display widely different trajectories in space and time, reflecting different emission reduction strategies and constraints due to administrative boundaries. The projected carbon emissions rely on future actions, hence uncertain, and we demonstrate how emission reductions vary significantly at the sub-city level. CONCLUSIONS: We conclude that quantified individual cities' climate actions are essential to construct more robust emissions trajectories at the city scale. Also, harmonization and compatibility of plans from various cities are necessary to make inter-comparisons of city climate targets possible. Furthermore, dense atmospheric networks extending beyond the city limits are needed to track emission trends over the coming decades.
RESUMEN
BACKGROUND: Purinergic signaling receptor Y12 (P2Y12) inhibitors are a fundamental part of pharmacological therapy in acute coronary syndrome (ACS) for preventing recurrent ischemic events. Current guidelines support the use of prasugrel over ticagrelor-however, ticagrelor is widely used for preclinical loading during ACS due to its ease of administration. In this regard, it remains unknown whether the preclinical loading with P2Y12 inhibitors impacts decision-making for the long-term dual antiplatelet strategy, as well as cardiovascular outcomes, including re-percutaneous coronary intervention in real-world settings. METHODS: Within this population-based prospective observational study, all patients with ACS who received medical care via the Emergency Medical Service (EMS) in the city of Vienna between January 2018 and October 2020 were enrolled. Patients were stratified according to their P2Y12 inhibitor loading regimen. Subsequently, the association of P2Y12 inhibitor loading on long-term prescription at discharge and outcome was assessed. RESULTS: The entire study cohort consisted of 1176 individuals with ST-elevation myocardial infarction (STEMI), of whom 47.5% received prasugrel and 52.5% ticagrelor. The likelihood of adhering to the initial P2Y12 inhibitor strategy during the clinical stay was high for both ticagrelor (84%; OR: 10.00; p < 0.001) and prasugrel (77%; OR: 21.26; p < 0.001). During patient follow-up (median follow-up time three years), 84 (7.1%) patients died due to cardiovascular causes, and 82 (7.0%) patients required re-PCI. Notably, there was no difference in cardiovascular mortality (6.6% ticagrelor vs. 7.7% prasugrel) or re-PCI rates (6.6% ticagrelor vs. 7.3% prasugrel) addressing the P2Y12 inhibition strategy. CONCLUSION: We observed that, regardless of the initial antiplatelet inhibitor strategy, the in-hospital P2Y12 adherence was exceedingly high, and there was a minimal occurrence of switching to another P2Y12 inhibitor. Most importantly, no significant difference in cardiovascular death/re-PCI between ticagrelor and prasugrel-based preclinical loading has been observed. Consequently, the choice of high potent P2Y12 did not influence the cardiac outcome from a long-term perspective.
